Provider Demographics
NPI:1235298597
Name:OGBUREKE, KALU UGWA (BDS)
Entity Type:Individual
Prefix:
First Name:KALU
Middle Name:UGWA
Last Name:OGBUREKE
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2032
Mailing Address - Country:US
Mailing Address - Phone:713-486-4406
Mailing Address - Fax:713-486-4416
Practice Address - Street 1:7500 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2032
Practice Address - Country:US
Practice Address - Phone:713-486-4406
Practice Address - Fax:713-486-4416
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285791223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA586469939AMedicaid
GA1418385OtherUNITED CONCORDIA
GA22BDFBTOtherMEDICARE
SCZG0326Medicaid