Provider Demographics
NPI:1053463927
Name:OKOROJI, SUNNY (MD,DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:
Last Name:OKOROJI
Suffix:
Gender:M
Credentials:MD,DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROCK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1989
Mailing Address - Country:US
Mailing Address - Phone:704-827-6436
Mailing Address - Fax:
Practice Address - Street 1:1312 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5129
Practice Address - Country:US
Practice Address - Phone:704-867-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice