Healthcare Provider Details

I. General information

NPI: 1124401732
Provider Name (Legal Business Name): CHRISTIAN MMADIBUOBU OKAFOR DDS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SOUTH COOLIDGE STREET, MOSES LAKE COMMUNITY HEALTH CENTER
MOSES LAKE WA
98837
US

IV. Provider business mailing address

1451 S 6TH WAY
RIDGEFIELD WA
98642-9246
US

V. Phone/Fax

Practice location:
  • Phone: 509-766-8977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60567260
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10275
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: