Healthcare Provider Details

I. General information

NPI: 1306581871
Provider Name (Legal Business Name): OKONEDO DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 PANTHER CREEK PKWY SUITE #300
FRISCO TX
75035
US

IV. Provider business mailing address

361 MOONVINE DR
LITTLE ELM TX
75068-1758
US

V. Phone/Fax

Practice location:
  • Phone: 945-348-3500
  • Fax:
Mailing address:
  • Phone: 202-468-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADESUWA OKONEDO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 202-468-8164