Provider Demographics
NPI:1205345576
Name:OKORO, CHIBUEZE GEORGE (DMD)
Entity type:Individual
Prefix:
First Name:CHIBUEZE
Middle Name:GEORGE
Last Name:OKORO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5355
Mailing Address - Country:US
Mailing Address - Phone:301-925-8600
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 100
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5355
Practice Address - Country:US
Practice Address - Phone:301-925-8600
Practice Address - Fax:301-925-8065
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18577721223G0001X
MD16627122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty