Provider Demographics
NPI:1275513046
Name:EKUNWE, CARLETTA BARNES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLETTA
Middle Name:BARNES
Last Name:EKUNWE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CARLETTA
Other - Middle Name:YALONDA
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5914 U S HIGHWAY 49 STE 10
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7577
Mailing Address - Country:US
Mailing Address - Phone:601-545-7055
Mailing Address - Fax:601-545-7058
Practice Address - Street 1:5914 U S HIGHWAY 49 STE 10
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7577
Practice Address - Country:US
Practice Address - Phone:601-545-7055
Practice Address - Fax:601-545-7058
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3248-03122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09832783Medicaid
MS04573273Medicaid
MS09823388Medicaid