Healthcare Provider Details

I. General information

NPI: 1164061453
Provider Name (Legal Business Name): EMAMEFE EWOMAZINO OKINEDO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMAMEFE EWOMAZINO OVEH BDS

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28818 INNES PARK PL
KATY TX
77494-6947
US

IV. Provider business mailing address

28818 INNES PARK PL
KATY TX
77494-6947
US

V. Phone/Fax

Practice location:
  • Phone: 662-380-0331
  • Fax:
Mailing address:
  • Phone: 662-380-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: