Provider Demographics
NPI:1174106538
Name:EZEJI, OBINNA (DDS)
Entity type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:
Last Name:EZEJI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:OBINNA
Other - Middle Name:
Other - Last Name:EZEJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12827 KITTY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-3721
Mailing Address - Country:US
Mailing Address - Phone:832-766-1500
Mailing Address - Fax:
Practice Address - Street 1:8243 COLGATE ST # A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1105
Practice Address - Country:US
Practice Address - Phone:832-766-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty