Provider Demographics
NPI:1386978583
Name:WADENYA, ROSE OGADA
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:OGADA
Last Name:WADENYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 S. EAGLE ROAD SUITE 100
Mailing Address - Street 2:EAGLE CREST PEDIATRIC DENTISTRY:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:484-454-3568
Mailing Address - Fax:
Practice Address - Street 1:31 S. EAGLE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:484-454-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030167-L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry