Provider Demographics
NPI:1588318992
Name:DRIVEN DENTAL PLLC
Entity type:Organization
Organization Name:DRIVEN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:OKWEREKWU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:612-423-7771
Mailing Address - Street 1:1520 6TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4584
Mailing Address - Country:US
Mailing Address - Phone:518-274-2660
Mailing Address - Fax:
Practice Address - Street 1:1520 6TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4584
Practice Address - Country:US
Practice Address - Phone:518-274-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty