Provider Demographics
NPI:1720564255
Name:NJOKU, EBERECHUKWU GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EBERECHUKWU
Middle Name:GAIL
Last Name:NJOKU
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 1:407 CREEK RUN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1951
Mailing Address - Country:US
Mailing Address - Phone:678-516-8619
Mailing Address - Fax:
Practice Address - Street 1:3 K MART PLZ
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4442
Practice Address - Country:US
Practice Address - Phone:678-516-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9202OtherLICENSE