Healthcare Provider Details

I. General information

NPI: 1538053541
Provider Name (Legal Business Name): CHUKWUMA ONYEKA OKAFOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 W 14TH ST
CHICAGO HEIGHTS IL
60411-2386
US

IV. Provider business mailing address

4425 175TH PL
COUNTRY CLUB HILLS IL
60478-4768
US

V. Phone/Fax

Practice location:
  • Phone: 708-283-9800
  • Fax: 708-283-9801
Mailing address:
  • Phone: 708-921-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.036229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: