Provider Demographics
NPI:1548423445
Name:NWOKORIE, UMUNNA CHRISTIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:UMUNNA
Middle Name:CHRISTIAN
Last Name:NWOKORIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 REEVES RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3855
Mailing Address - Country:US
Mailing Address - Phone:940-627-8400
Mailing Address - Fax:940-627-8402
Practice Address - Street 1:2100 REEVES RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3855
Practice Address - Country:US
Practice Address - Phone:940-627-8400
Practice Address - Fax:940-627-8402
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX25799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215320712Medicaid