Provider Demographics
NPI:1437508496
Name:OKORONKWO, ONYEKACHUKWU GIFT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ONYEKACHUKWU
Middle Name:GIFT
Last Name:OKORONKWO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MIAMI CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5210
Mailing Address - Country:US
Mailing Address - Phone:410-698-7218
Mailing Address - Fax:
Practice Address - Street 1:4 MIAMI CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5210
Practice Address - Country:US
Practice Address - Phone:410-698-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist