Organization
OKUMU DENTAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER OKUMU NGAJI-OKUMU DDS (OWNER)
(610) 466-9545
Entity
Organization
Contact information
Practice address
1131 OLIVE ST, COATESVILLE, PA 19320-3518
(610) 466-9545
(610) 466-9545
Mailing address
1131 OLIVE ST, COATESVILLE, PA 19320-3518
(610) 466-9545
(610) 466-9545
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DS036492
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018743640002
—
PA
01
—
DS036492
DENTIST LICENSE
PA
Enumeration date
11/03/2006
Last updated
10/07/2011
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