Provider Demographics
NPI:1942686225
Name:OKAFOR, IKENNA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:IKENNA
Middle Name:K
Last Name:OKAFOR
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 1:1652 PAT BOOKER RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3433
Mailing Address - Country:US
Mailing Address - Phone:210-658-4011
Mailing Address - Fax:210-658-3471
Practice Address - Street 1:1652 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3433
Practice Address - Country:US
Practice Address - Phone:210-658-4011
Practice Address - Fax:210-658-3471
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31579122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist