Provider Demographics
NPI:1962571224
Name:GAINES-ONIWINDE, CONDRA G (DDS)
Entity type:Individual
Prefix:DR
First Name:CONDRA
Middle Name:G
Last Name:GAINES-ONIWINDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WOODBRIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1152
Mailing Address - Country:US
Mailing Address - Phone:732-914-3991
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:1146 STUYVESANT AVENUE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-399-4242
Practice Address - Fax:973-399-4440
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI21154001223G0001X
NJDI0211541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice