Provider Demographics
NPI:1073577912
Name:OJIMBA, JACQUELINE IJEOMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:IJEOMA
Last Name:OJIMBA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N. BELAIR ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-504-4903
Mailing Address - Fax:
Practice Address - Street 1:104 N. BELAIR ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-504-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-0505911223G0001X
GADN0138521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151205AMedicaid