Healthcare Provider Details

I. General information

NPI: 1780055483
Provider Name (Legal Business Name): UZOMA CHINEDU OBAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 FREDERICKSBURG RD STE A
SAN ANTONIO TX
78201-6521
US

IV. Provider business mailing address

24233 AMARA WAY
SAN ANTONIO TX
78261-4438
US

V. Phone/Fax

Practice location:
  • Phone: 210-530-8841
  • Fax:
Mailing address:
  • Phone: 270-929-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number09 06949 00
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35804
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: