Provider Demographics
NPI:1528371978
Name:AKHARUME, EHIDANMEGBE OKUNWA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EHIDANMEGBE
Middle Name:OKUNWA
Last Name:AKHARUME
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 1:730 CHAMBORD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-4016
Mailing Address - Country:US
Mailing Address - Phone:601-212-9653
Mailing Address - Fax:
Practice Address - Street 1:3455 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-341-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63371223G0001X
MS4025-181223G0001X
TN123G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice