Provider Demographics
NPI:1851979025
Name:ANYAMELE, OKECHUKWU (DDS)
Entity type:Individual
Prefix:DR
First Name:OKECHUKWU
Middle Name:
Last Name:ANYAMELE
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 1:400 BLAKE ST APT 4315
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-4420
Mailing Address - Country:US
Mailing Address - Phone:601-398-7111
Mailing Address - Fax:
Practice Address - Street 1:26 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2442
Practice Address - Country:US
Practice Address - Phone:601-984-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT140011223G0001X
MS4252-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice