Provider Demographics
NPI:1952840274
Name:ESONU, ONYINYECHI KELECHUKWU (DMD)
Entity Type:Individual
Prefix:
First Name:ONYINYECHI
Middle Name:KELECHUKWU
Last Name:ESONU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1671
Mailing Address - Country:US
Mailing Address - Phone:708-316-2056
Mailing Address - Fax:
Practice Address - Street 1:620 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1671
Practice Address - Country:US
Practice Address - Phone:708-316-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR60757258204E00000X
IL019.0341181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery