Healthcare Provider Details

I. General information

NPI: 1003586785
Provider Name (Legal Business Name): UDECHUKWU IHEDURU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S IDAHO RD STE 260
APACHE JUNCTION AZ
85119-2379
US

IV. Provider business mailing address

2065 E SADDLEBROOK CT
GILBERT AZ
85298-7416
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0782
  • Fax:
Mailing address:
  • Phone: 602-750-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011871
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: