Provider Demographics
NPI:1174793251
Name:DR SUNNY OKOROJI, MS,DDS,PA
Entity type:Organization
Organization Name:DR SUNNY OKOROJI, MS,DDS,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOROJI
Authorized Official - Suffix:
Authorized Official - Credentials:MS,DDS,PA
Authorized Official - Phone:704-867-0766
Mailing Address - Street 1:1312 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5129
Mailing Address - Country:US
Mailing Address - Phone:704-867-0766
Mailing Address - Fax:704-861-9104
Practice Address - Street 1:1312 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5129
Practice Address - Country:US
Practice Address - Phone:704-867-0766
Practice Address - Fax:704-861-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty