Healthcare Provider Details

I. General information

NPI: 1568049179
Provider Name (Legal Business Name): CHINNAYA IJEOMA UKPABI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1896 KENNARD CT
SNELLVILLE GA
30078-2092
US

IV. Provider business mailing address

1262 VINTAGE POINTE DR
LAWRENCEVILLE GA
30044-3277
US

V. Phone/Fax

Practice location:
  • Phone: 688-525-6384
  • Fax:
Mailing address:
  • Phone: 678-525-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: