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General NPI Number Information
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NPI Number | 1770745333
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Entity Type | Individual
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Provider Name | EBUN SUSAN OLA-JOHN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 40 PITTS SCHOOL RD SW
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City | CONCORD
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State | NC
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Zip | 28027-3931
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Country | US
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Telephone | 704-461-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 40 PITTS SCHOOL RD SW
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City | CONCORD
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State | NC
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Zip | 28027-3931
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Country | US
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Telephone | 704-461-0707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019027711
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13521
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License Number State | NC
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