Provider Demographics
NPI:1831409366
Name:IKEM, KACHIKWULU CHUKWUEMEKA (DDS)
Entity type:Individual
Prefix:DR
First Name:KACHIKWULU
Middle Name:CHUKWUEMEKA
Last Name:IKEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S LANCASTER RD STE 760
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-8823
Mailing Address - Country:US
Mailing Address - Phone:214-375-4100
Mailing Address - Fax:
Practice Address - Street 1:3590 N ZARAGOZA RD STE 105-106
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8009
Practice Address - Country:US
Practice Address - Phone:915-855-4444
Practice Address - Fax:915-990-2002
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist