Healthcare Provider Details

I. General information

NPI: 1346862117
Provider Name (Legal Business Name): CYPRIAN CHIBUZOR OKOBI JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 AMESBURY DR APT 514
DALLAS TX
75206-4896
US

IV. Provider business mailing address

4646 AMESBURY DR APT 514
DALLAS TX
75206-4896
US

V. Phone/Fax

Practice location:
  • Phone: 469-733-7345
  • Fax:
Mailing address:
  • Phone: 469-733-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35981
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: