Healthcare Provider Details

I. General information

NPI: 1790603074
Provider Name (Legal Business Name): CHIEMEZUO JEAN OKONKWO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN OKONKWO DDS

II. Dates (important events)

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

III. Provider practice location address

1001 STADIUM DR
WAKE FOREST NC
27587-4655
US

IV. Provider business mailing address

654 GIMARI DR
WAKE FOREST NC
27587-3390
US

V. Phone/Fax

Practice location:
  • Phone: 984-213-4412
  • Fax:
Mailing address:
  • Phone: 984-370-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14821
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: