Provider Demographics
NPI:1659356830
Name:IGBINADOLOR, UYIEKPEN PHILLIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:UYIEKPEN
Middle Name:PHILLIP
Last Name:IGBINADOLOR
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0488
Mailing Address - Country:US
Mailing Address - Phone:704-238-8727
Mailing Address - Fax:704-238-8757
Practice Address - Street 1:701 E ROOSEVELT BLVD
Practice Address - Street 2:BLDG 800-B
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5170
Practice Address - Country:US
Practice Address - Phone:704-238-8727
Practice Address - Fax:704-238-8757
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127MYOtherBCBSNC #
NC89127MYMedicaid