Provider Demographics
NPI:1215427513
Name:OKONEDO, ADESUWA (DDS)
Entity type:Individual
Prefix:
First Name:ADESUWA
Middle Name:
Last Name:OKONEDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADSUWA
Other - Middle Name:
Other - Last Name:OKONEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2611 ROSS AVE APT 5038
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2558
Mailing Address - Country:US
Mailing Address - Phone:202-468-8164
Mailing Address - Fax:
Practice Address - Street 1:3250 W PLEASANT RUN RD STE 190
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1041
Practice Address - Country:US
Practice Address - Phone:469-765-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist