Provider Demographics
NPI:1699550483
Name:EXTRACTION KING PLLC
Entity type:Organization
Organization Name:EXTRACTION KING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBERECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEANACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-627-0525
Mailing Address - Street 1:4501 W EXPRESSWAY 83 # 10
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-0029
Mailing Address - Country:US
Mailing Address - Phone:956-627-0525
Mailing Address - Fax:956-322-8982
Practice Address - Street 1:4501 W EXPRESSWAY 83 # 10
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-0029
Practice Address - Country:US
Practice Address - Phone:956-627-0525
Practice Address - Fax:956-322-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental