MEDICARE: DR. IFECHI OBIORA NDUKA 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
1	1223G0001X	General Practice Dentistry	38612	TX

General Provider Information

NPI Number	:	1508596560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFECHI OBIORA NDUKA DDS

Provider Business Mailing Address
First Line	:	12770 MERIT DR STE 850
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1438
Country	:	US
Telephone Number	:	972-361-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 S STATE HIGHWAY 161 STE 200
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7281
Country	:	US
Telephone Number	:	972-820-7214
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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