Healthcare Provider Details

I. General information

NPI: 1720564255
Provider Name (Legal Business Name): EBERECHUKWU GAIL NJOKU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 K MART PLZ
GREENVILLE SC
29605-4442
US

IV. Provider business mailing address

407 CREEK RUN DR
WOODSTOCK GA
30188-1951
US

V. Phone/Fax

Practice location:
  • Phone: 678-516-8619
  • Fax:
Mailing address:
  • Phone: 678-516-8619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9202
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: