1205893492 NPI number — ISIOMA ANTHONIA OKONMAH D. D. S., M.P.H.

Table of content: ISIOMA ANTHONIA OKONMAH D. D. S., M.P.H. (NPI 1205893492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205893492 NPI number — ISIOMA ANTHONIA OKONMAH D. D. S., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKONMAH
Provider First Name:
ISIOMA
Provider Middle Name:
ANTHONIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D. D. S., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBAZEE
Provider Other First Name:
ISIOMA
Provider Other Middle Name:
ANTHONIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205893492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 STATESVILLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28144-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-637-2120
Provider Business Mailing Address Fax Number:
704-637-1283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 STATESVILLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-637-2120
Provider Business Practice Location Address Fax Number:
704-637-1283
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7842 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89902X7 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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