Provider Demographics
NPI:1982299236
Name:OMERE, VIRTUE EBOHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRTUE
Middle Name:EBOHI
Last Name:OMERE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VIRTUE
Other - Middle Name:EBOHI
Other - Last Name:AKHIDIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 NORTHSHORE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0077
Mailing Address - Country:US
Mailing Address - Phone:940-208-8875
Mailing Address - Fax:
Practice Address - Street 1:575 E FM 150
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6200
Practice Address - Country:US
Practice Address - Phone:512-268-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX393251223G0001X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program