Healthcare Provider Details

I. General information

NPI: 1053463927
Provider Name (Legal Business Name): SUNNY OKOROJI MD,DDS,PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 E GARRISON BLVD
GASTONIA NC
28054-5129
US

IV. Provider business mailing address

100 ROCK RIDGE LN
MOUNT HOLLY NC
28120-1989
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-0766
  • Fax:
Mailing address:
  • Phone: 704-827-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: