MEDICARE: DR. UDUAK ANAKO-OKEREKE D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17717	MA

General Provider Information

NPI Number	:	1073633996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UDUAK ANAKO-OKEREKE D.M.D

Provider Business Mailing Address
First Line	:	67 HIGHLAND AVE
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-3922
Country	:	US
Telephone Number	:	617-825-3400
Fax Number	:	617-825-7217

Provider Business Practice Location Address
First Line	:	632 BLUE HILL AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-3213
Country	:	US
Telephone Number	:	617-825-3400
Fax Number	:	617-825-7217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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