Provider Demographics
NPI:1427502921
Name:UKHUREBOR, WILFRED OMOGHIBORA (DDS)
Entity type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:OMOGHIBORA
Last Name:UKHUREBOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-5214
Mailing Address - Country:US
Mailing Address - Phone:425-761-6990
Mailing Address - Fax:
Practice Address - Street 1:1400 N CENTER ST STE 100
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3036
Practice Address - Country:US
Practice Address - Phone:903-304-5810
Practice Address - Fax:903-304-5808
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32166122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist