Provider Demographics
NPI:1891983532
Name:UMEOZULU, OKEOMA NNEKA
Entity type:Individual
Prefix:
First Name:OKEOMA
Middle Name:NNEKA
Last Name:UMEOZULU
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 1:932 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4884
Mailing Address - Country:US
Mailing Address - Phone:443-629-3613
Mailing Address - Fax:903-893-9877
Practice Address - Street 1:1827 TEXOMA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2906
Practice Address - Country:US
Practice Address - Phone:443-629-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141931223G0001X
TX24918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice