MEDICARE: JUDITH OGIEMWENVA OJO DMD

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	122300000X	Dentist	33177	TX

General Provider Information

NPI Number	:	1164943486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH OGIEMWENVA OJO DMD

Provider Business Mailing Address
First Line	:	2339 E EVANS RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2718
Country	:	US
Telephone Number	:	210-503-0230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 E EVANS RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2718
Country	:	US
Telephone Number	:	210-503-0230
Fax Number	:

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

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	03/20/2020

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