Individual
DR. BONAVENTURE CHISOM NWOKOCHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
7960 BROOKLYN BLVD, BROOKLYN PARK, MN 55445-2722
(763) 710-9937
(763) 710-9968
Mailing address
16420 57TH AVE N, PLYMOUTH, MN 55446-3728
(618) 593-2130
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12960
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174913339
—
MN
05
—
1356749659
—
MN
Enumeration date
05/22/2011
Last updated
09/09/2020
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