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General NPI Number Information
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NPI Number | 1396071577
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Entity Type | Organization
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Legal Business Name | ISIOMA A. OKONMAH D.D.S., M.P.H., P.A.
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 408 STATESVILLE BLVD
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City | SALISBURY
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State | NC
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Zip | 28144-2318
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Country | US
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Telephone | 704-637-2120
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Fax | 704-637-1283
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Provider Business Mailing Address
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Address Line | 408 STATESVILLE BLVD
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City | SALISBURY
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State | NC
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Zip | 28144-2318
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Country | US
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Telephone | 704-637-2120
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Fax | 704-637-1283
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ISIOMA ANTHONIA OKONMAH
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Credential | D.D.S., M.P.H.
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Telephone | 908-906-8172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7842
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License Number State | NC
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