Provider Demographics
NPI:1285091231
Name:UYIGUE, UWADIAE (DDS)
Entity type:Individual
Prefix:DR
First Name:UWADIAE
Middle Name:
Last Name:UYIGUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 S BROADWAY ST UNIT A1
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-3283
Mailing Address - Country:US
Mailing Address - Phone:682-317-9342
Mailing Address - Fax:682-317-9448
Practice Address - Street 1:443 S BROADWAY ST UNIT A1
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-3283
Practice Address - Country:US
Practice Address - Phone:682-317-9342
Practice Address - Fax:682-317-9448
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31648122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist