Healthcare Provider Details

I. General information

NPI: 1659170009
Provider Name (Legal Business Name): MICHAEL OKORO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 TAYLOR DR
BARTLESVILLE OK
74006-7827
US

IV. Provider business mailing address

7952 AMAWALK CIR
JOHNS CREEK GA
30097-1920
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0000
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: