Healthcare Provider Details

I. General information

NPI: 1205345576
Provider Name (Legal Business Name): CHIBUEZE GEORGE OKORO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
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: 301-925-8600
  • Fax: 301-925-8065
Mailing address:
  • Phone: 301-925-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1857772
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16627
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: