Provider Demographics
NPI:1124492087
Name:EZEJI-OKOYE, CHINEDU JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHINEDU
Middle Name:JOHN
Last Name:EZEJI-OKOYE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:OKOYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1519 HIGH PARK DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:HIGH RIVER
Mailing Address - State:AB
Mailing Address - Zip Code:T1V0A4
Mailing Address - Country:CA
Mailing Address - Phone:403-701-6272
Mailing Address - Fax:
Practice Address - Street 1:1526 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1852
Practice Address - Country:US
Practice Address - Phone:415-453-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist