Provider Demographics
NPI:1518105071
Name:ANIEMEKE, JOHN CHUKWUEDUM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHUKWUEDUM
Last Name:ANIEMEKE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 ST CHARLES BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2085
Mailing Address - Country:US
Mailing Address - Phone:210-548-0440
Mailing Address - Fax:
Practice Address - Street 1:4145 ST CHARLES BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2085
Practice Address - Country:US
Practice Address - Phone:210-548-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX246421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program