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NPI Code Detail

MEDICARE: DR. KENECHI FLORENCE UDEOZO DDS

MEDICARE: DR. KENECHI FLORENCE UDEOZO DDS
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
1122300000XDentist019028236IL
2122300000XDentist12011400AIN

General Provider Information

NPI Number : 1174849830
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENECHI FLORENCE UDEOZO DDS
Provider Business Mailing Address
First Line : 201 W 8TH ST
Second Line : SUITE 810
City : PUEBLO
State : CO
Zip : 81003-3038
Country : US
Telephone Number : 719-562-4447
Fax Number : 719-583-1801
Provider Business Practice Location Address
First Line : 5430 E WASHINGTON ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-6446
Country : US
Telephone Number : 317-322-1840
Fax Number : 317-322-1842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2010
Last Update Date : 12/13/2019

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