=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841796489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IODDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2018
-----------------------------------------------------
Last Update Date | 03/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8190 BARKER CYPRESS RD STE 200
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-2279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-967-7332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8190 BARKER CYPRESS RD STE 200
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-2279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. IRABOR I OKOGBO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 832-674-4932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 27752
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------