Provider Demographics
NPI:1568049179
Name:UKPABI, CHINNAYA IJEOMA (DDS)
Entity Type:Individual
Prefix:
First Name:CHINNAYA
Middle Name:IJEOMA
Last Name:UKPABI
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 1:1262 VINTAGE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3277
Mailing Address - Country:US
Mailing Address - Phone:678-525-6384
Mailing Address - Fax:
Practice Address - Street 1:1896 KENNARD CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2092
Practice Address - Country:US
Practice Address - Phone:688-525-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist