MEDICARE: KALU UGWA OGBUREKE BDS

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	28579	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	28579	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	22BDFBT	OTHER	GA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1418385	OTHER	GA	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235298597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALU UGWA OGBUREKE BDS

Provider Business Mailing Address
First Line	:	7500 CAMBRIDGE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2032
Country	:	US
Telephone Number	:	713-486-4406
Fax Number	:	713-486-4416

Provider Business Practice Location Address
First Line	:	7500 CAMBRIDGE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2032
Country	:	US
Telephone Number	:	713-486-4406
Fax Number	:	713-486-4416

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	09/27/2024

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Directions to “ KALU UGWA OGBUREKE BDS” Practice Location

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