Healthcare Provider Details

I. General information

NPI: 1417401134
Provider Name (Legal Business Name): SHEDRACK OKOJIE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 BARROW ST
ABILENE TX
79605-5171
US

IV. Provider business mailing address

3920 AVIATOR DR
ABILENE TX
79606-1832
US

V. Phone/Fax

Practice location:
  • Phone: 325-480-4248
  • Fax:
Mailing address:
  • Phone: 646-256-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: