Healthcare Provider Details

I. General information

NPI: 1750100079
Provider Name (Legal Business Name): KENECHI OKANY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 HOOPER AVE UNIT 4
BRICK NJ
08723-4160
US

IV. Provider business mailing address

2770 HOOPER AVE UNIT 4
BRICK NJ
08723-4160
US

V. Phone/Fax

Practice location:
  • Phone: 609-489-0030
  • Fax:
Mailing address:
  • Phone: 732-965-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI03055100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: