Provider Demographics
NPI:1366000481
Name:OGUEJIOFOR, IFEOMA CLEMENTINA (DMD)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:CLEMENTINA
Last Name:OGUEJIOFOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6129
Mailing Address - Country:US
Mailing Address - Phone:919-349-6462
Mailing Address - Fax:
Practice Address - Street 1:320 NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2424
Practice Address - Country:US
Practice Address - Phone:910-596-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11412122300000X
AZD011569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist