Healthcare Provider Details

I. General information

NPI: 1508727405
Provider Name (Legal Business Name): ONYINYEOMA CRYSTAL OKOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GREENWAY CENTER DR STE 102
GREENBELT MD
20770-3525
US

IV. Provider business mailing address

4909 GRID ST
BOWIE MD
20720-3415
US

V. Phone/Fax

Practice location:
  • Phone: 301-778-2806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18801
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: