Healthcare Provider Details

I. General information

NPI: 1659296416
Provider Name (Legal Business Name): CHISOHLM CHUKWU II PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S SALISBURY AVE
SPENCER NC
28159-2015
US

IV. Provider business mailing address

902 S SALISBURY AVE
SPENCER NC
28159-2015
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-7215
  • Fax:
Mailing address:
  • Phone: 704-636-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHISOHLM IBEZIM CHUKWU
Title or Position: PRESIDENT
Credential: MD, DMD
Phone: 704-636-7215