MEDICARE: NEO MAMORAKA EHIWE

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	12916	NC

General Provider Information

NPI Number	:	1942947858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEO MAMORAKA EHIWE

Provider Business Mailing Address
First Line	:	13760 ALDENBROOK DR
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-4232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 US HIGHWAY 70 SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-5164
Country	:	US
Telephone Number	:	828-270-3033
Fax Number	:

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

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	07/15/2022

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Directions to “ NEO MAMORAKA EHIWE ” Practice Location

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