Provider Demographics
NPI:1518333095
Name:PIONEER DENTISTRY OF CONROE, PLLC
Entity Type:Organization
Organization Name:PIONEER DENTISTRY OF CONROE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OKEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:OKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-223-7662
Mailing Address - Street 1:4157 N. O'CONNOR ROAD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:214-223-7662
Mailing Address - Fax:940-220-4451
Practice Address - Street 1:727B W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2704
Practice Address - Country:US
Practice Address - Phone:214-223-7662
Practice Address - Fax:940-220-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty