Healthcare Provider Details

I. General information

NPI: 1285462457
Provider Name (Legal Business Name): UCHECHUKWU COLETTE OKONKWO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N GLENSTONE AVE
SPRINGFIELD MO
65802-2132
US

IV. Provider business mailing address

4214 S FARM ROAD 135
SPRINGFIELD MO
65810-3716
US

V. Phone/Fax

Practice location:
  • Phone: 417-929-3728
  • Fax:
Mailing address:
  • Phone: 417-289-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026028662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: