Healthcare Provider Details

I. General information

NPI: 1497786941
Provider Name (Legal Business Name): EZINNE I OGBUREKE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CAMBRIDGE STREET SOD 5330
HOUSTON TX
77054
US

IV. Provider business mailing address

1120 15TH ST GC-1024
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-4261
  • Fax: 713-486-4108
Mailing address:
  • Phone: 706-721-9633
  • Fax: 706-723-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: