Healthcare Provider Details

I. General information

NPI: 1770152597
Provider Name (Legal Business Name): DR. ASHLY OKOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E ALLEGHENY AVE
PHILADELPHIA PA
19134-4427
US

IV. Provider business mailing address

900 N 9TH ST APT 405
PHILADELPHIA PA
19123-1221
US

V. Phone/Fax

Practice location:
  • Phone: 682-234-2417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DR03651
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: