Provider Demographics
NPI:1164943486
Name:OJO, JUDITH OGIEMWENVA (DMD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:OGIEMWENVA
Last Name:OJO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:OGIEMWENVA
Other - Last Name:OSIFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2339 E EVANS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2718
Mailing Address - Country:US
Mailing Address - Phone:210-503-0230
Mailing Address - Fax:
Practice Address - Street 1:2339 E EVANS RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2718
Practice Address - Country:US
Practice Address - Phone:210-503-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist