Provider Demographics
NPI:1760827711
Name:OKORO, CHINYERE MABEL (DDS)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:MABEL
Last Name:OKORO
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 1:4335 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4818
Mailing Address - Country:US
Mailing Address - Phone:423-479-5400
Mailing Address - Fax:423-339-2228
Practice Address - Street 1:4335 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4818
Practice Address - Country:US
Practice Address - Phone:423-479-5400
Practice Address - Fax:423-339-2228
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9763122300000X
MD15594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist