Provider Demographics
NPI:1255404240
Name:GILKEY-ONUIGBO, JACQUELINE L (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:L
Last Name:GILKEY-ONUIGBO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:L
Other - Last Name:GILKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:803 LANDING PT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9064
Mailing Address - Country:US
Mailing Address - Phone:478-953-2836
Mailing Address - Fax:678-843-8601
Practice Address - Street 1:2745 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8078
Practice Address - Country:US
Practice Address - Phone:478-953-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG1371OtherMEDICAID SC
GA265434568DMedicaid
GA9183452OtherDENTAQUEST GA
GA000686628CMedicaid