Healthcare Provider Details

I. General information

NPI: 1427502921
Provider Name (Legal Business Name): WILFRED OMOGHIBORA UKHUREBOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N CENTER ST STE 100
BONHAM TX
75418-3036
US

IV. Provider business mailing address

206 NE 7TH AVE
AMARILLO TX
79107-5214
US

V. Phone/Fax

Practice location:
  • Phone: 903-304-5810
  • Fax: 903-304-5808
Mailing address:
  • Phone: 425-761-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32166
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: