Provider Demographics
NPI:1639345572
Name:IMO, CHIOMA N (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:N
Last Name:IMO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHIOMA
Other - Middle Name:N
Other - Last Name:IMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2536 AMHERST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3207
Mailing Address - Country:US
Mailing Address - Phone:713-490-8880
Mailing Address - Fax:
Practice Address - Street 1:6245 HIGHWAY 6 STE 400
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4765
Practice Address - Country:US
Practice Address - Phone:281-969-5099
Practice Address - Fax:281-969-7729
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35506122300000X
MD12941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist