Provider Demographics
NPI:1427726280
Name:OKOTIE-EBOH, ROLI GRACE
Entity type:Individual
Prefix:
First Name:ROLI
Middle Name:GRACE
Last Name:OKOTIE-EBOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 STEINHAGEN RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7173
Mailing Address - Country:US
Mailing Address - Phone:281-650-7513
Mailing Address - Fax:
Practice Address - Street 1:1911 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3990
Practice Address - Country:US
Practice Address - Phone:713-868-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice