Provider Demographics
NPI:1760484463
Name:OKEMWA, JUANITA (BDS)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:
Last Name:OKEMWA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2417
Mailing Address - Country:US
Mailing Address - Phone:626-585-9455
Mailing Address - Fax:626-449-4932
Practice Address - Street 1:10842 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3610
Practice Address - Country:US
Practice Address - Phone:310-559-2935
Practice Address - Fax:310-559-0859
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics