Provider Demographics
NPI:1417401134
Name:OKOJIE, SHEDRACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEDRACK
Middle Name:
Last Name:OKOJIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 AVIATOR DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1832
Mailing Address - Country:US
Mailing Address - Phone:646-256-2551
Mailing Address - Fax:
Practice Address - Street 1:1365 BARROW ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5171
Practice Address - Country:US
Practice Address - Phone:325-480-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist