Provider Demographics
NPI:1396383345
Name:ISIOMA A OKONMAH, D.D.S., M.P.H., P.A. CONCORD
Entity Type:Organization
Organization Name:ISIOMA A OKONMAH, D.D.S., M.P.H., P.A. CONCORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONMAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-780-4333
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-1082
Mailing Address - Country:US
Mailing Address - Phone:704-780-4333
Mailing Address - Fax:704-780-4330
Practice Address - Street 1:538 LAKE CONCORD RD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2926
Practice Address - Country:US
Practice Address - Phone:704-780-4333
Practice Address - Fax:704-780-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty