Healthcare Provider Details

I. General information

NPI: 1972119352
Provider Name (Legal Business Name): DUKE OSITA OKEKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 DALLAS HWY
VILLA RICA GA
30180-1906
US

IV. Provider business mailing address

3343 PEACHTREE RD NE STE 145
ATLANTA GA
30326-1427
US

V. Phone/Fax

Practice location:
  • Phone: 770-459-5778
  • Fax:
Mailing address:
  • Phone: 404-913-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: