Provider Demographics
NPI:1992142806
Name:EGOLUM, NKEMAKONAM (DDS)
Entity type:Individual
Prefix:DR
First Name:NKEMAKONAM
Middle Name:
Last Name:EGOLUM
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 1:10700 MEDLOCK BRIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8455
Mailing Address - Country:US
Mailing Address - Phone:770-764-0840
Mailing Address - Fax:770-764-0870
Practice Address - Street 1:10700 MEDLOCK BRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8455
Practice Address - Country:US
Practice Address - Phone:770-764-0840
Practice Address - Fax:770-764-0870
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1229751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery