Healthcare Provider Details

I. General information

NPI: 1164083069
Provider Name (Legal Business Name): BERNARD SANYA OKUMU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E US HIGHWAY 83
MCALLEN TX
78501-8818
US

IV. Provider business mailing address

7504 CONTINENTAL PKWY
AMARILLO TX
79119-6376
US

V. Phone/Fax

Practice location:
  • Phone: 965-994-0349
  • Fax: 965-994-0988
Mailing address:
  • Phone: 806-443-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: