Provider Demographics
NPI:1043683733
Name:IHENATU, IKECHUKWU
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:
Last Name:IHENATU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 BLACK CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4244
Mailing Address - Country:US
Mailing Address - Phone:919-593-3791
Mailing Address - Fax:
Practice Address - Street 1:2721 BLACK CHERRY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4244
Practice Address - Country:US
Practice Address - Phone:919-593-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT117481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice