Healthcare Provider Details

I. General information

NPI: 1194328203
Provider Name (Legal Business Name): EZE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MERCANTILE LN STE 100
LARGO MD
20774-5355
US

IV. Provider business mailing address

1400 MERCANTILE LN STE 100
LARGO MD
20774-5355
US

V. Phone/Fax

Practice location:
  • Phone: 857-269-9114
  • Fax:
Mailing address:
  • Phone: 301-925-8600
  • Fax: 301-925-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIBUEZE GEORGE OKORO
Title or Position: CEO/OWNER
Credential: DMD
Phone: 857-269-9114