Provider Demographics
NPI:1205893492
Name:OKONMAH, ISIOMA ANTHONIA (D D S, MPH)
Entity type:Individual
Prefix:
First Name:ISIOMA
Middle Name:ANTHONIA
Last Name:OKONMAH
Suffix:
Gender:F
Credentials:D D S, MPH
Other - Prefix:
Other - First Name:ISIOMA
Other - Middle Name:ANTHONIA
Other - Last Name:OBAZEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2318
Mailing Address - Country:US
Mailing Address - Phone:704-637-2120
Mailing Address - Fax:704-637-1283
Practice Address - Street 1:408 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2318
Practice Address - Country:US
Practice Address - Phone:704-637-2120
Practice Address - Fax:704-637-1283
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902X7Medicaid
U41475Medicare UPIN