Provider Demographics
NPI:1477122539
Name:ORADIEGWU, OKEYSOLOM KENNETH JR (DDS)
Entity type:Individual
Prefix:DR
First Name:OKEYSOLOM
Middle Name:KENNETH
Last Name:ORADIEGWU
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KESO
Other - Middle Name:KENNETH
Other - Last Name:ORADIEGWU
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11917 GATEWAY BLVD W STE G
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11917 GATEWAY BLVD W STE G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7479
Practice Address - Country:US
Practice Address - Phone:159-317-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice