Provider Demographics
NPI:1235815937
Name:OSAGHAE, UKPE THEODORA
Entity type:Individual
Prefix:
First Name:UKPE
Middle Name:THEODORA
Last Name:OSAGHAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UKPE
Other - Middle Name:T
Other - Last Name:OSAGHAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6666 SECURITY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6666 SECURITY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4025
Practice Address - Country:US
Practice Address - Phone:484-273-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD188331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program