Healthcare Provider Details

I. General information

NPI: 1629418371
Provider Name (Legal Business Name): YOUNG OKEKE DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 12/06/2022
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 PEACHTREE ST NE STE 705
ATLANTA GA
30309-3964
US

IV. Provider business mailing address

999 PEACHTREE ST NE STE 705
ATLANTA GA
30309-3964
US

V. Phone/Fax

Practice location:
  • Phone: 404-885-1441
  • Fax: 404-885-1410
Mailing address:
  • Phone: 404-885-1441
  • Fax: 404-885-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN015382
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: