Healthcare Provider Details

I. General information

NPI: 1689271835
Provider Name (Legal Business Name): PERPETUA OKOJIE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PERPETUA A OKOJIE DDS

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 SHERWOOD WAY
SAN ANGELO TX
76901-3926
US

IV. Provider business mailing address

41 TRACIE TRL
SAN ANGELO TX
76903-9148
US

V. Phone/Fax

Practice location:
  • Phone: 325-617-2914
  • Fax: 325-617-5708
Mailing address:
  • Phone: 646-753-4800
  • Fax: 325-617-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: