Healthcare Provider Details

I. General information

NPI: 1639602980
Provider Name (Legal Business Name): CHUKWUKA M OKAFOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S CLAYTON ST STE 28
LAWRENCEVILLE GA
30046-5753
US

IV. Provider business mailing address

1775 GRAND CONCOURSE 6TH FLOOR
BRONX NY
10453-8202
US

V. Phone/Fax

Practice location:
  • Phone: 678-230-0597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: