Provider Demographics
NPI:1205463502
Name:EARLEY, IBIFURO OGECHI OGBANGA (DDS)
Entity type:Individual
Prefix:
First Name:IBIFURO
Middle Name:OGECHI OGBANGA
Last Name:EARLEY
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 1:2536 AMHERST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3207
Mailing Address - Country:US
Mailing Address - Phone:713-490-8880
Mailing Address - Fax:281-417-4008
Practice Address - Street 1:3402 HIGHWAY 6 S STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4207
Practice Address - Country:US
Practice Address - Phone:281-759-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX388981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program