Provider Demographics
NPI:1740987312
Name:LUSH DENTAL AND IMPLANTS
Entity type:Organization
Organization Name:LUSH DENTAL AND IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEDRACK
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOJIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-256-2551
Mailing Address - Street 1:2970 FORT WORTH HWY # 200
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4996
Mailing Address - Country:US
Mailing Address - Phone:682-394-0955
Mailing Address - Fax:682-394-0956
Practice Address - Street 1:2970 FORT WORTH HWY # 200
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-4996
Practice Address - Country:US
Practice Address - Phone:682-394-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental