Provider Demographics
NPI:1669648580
Name:EZE, KENECHUKWU OBIDIGWE (DDS)
Entity Type:Individual
Prefix:
First Name:KENECHUKWU
Middle Name:OBIDIGWE
Last Name:EZE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 S. LAND PARK DR.
Mailing Address - Street 2:
Mailing Address - City:SAC
Mailing Address - State:CA
Mailing Address - Zip Code:95822
Mailing Address - Country:US
Mailing Address - Phone:916-500-5437
Mailing Address - Fax:916-244-7004
Practice Address - Street 1:6030 S. LAND PARK DR.
Practice Address - Street 2:
Practice Address - City:SAC
Practice Address - State:CA
Practice Address - Zip Code:95822
Practice Address - Country:US
Practice Address - Phone:916-500-5437
Practice Address - Fax:916-244-7004
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294001223G0001X
CA569541223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice