Provider Demographics
NPI:1932599651
Name:EJIKE, OBINNA EJIKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:EJIKE
Last Name:EJIKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:OBINNA
Other - Middle Name:EJIKE
Other - Last Name:ONWUZULIGBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14024 MASSIMA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2846 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4193
Practice Address - Country:US
Practice Address - Phone:210-545-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX316751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program