Ebo, Ikechukwu P.
Ebo, Ikechukwu P. is an sole proprietor health care provider with primary practice located at 650 Gwinnett Dr , Lawrenceville GA 30046-7439. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / Dentist is his primary health care specialty. Ebo, Ikechukwu P. can be contacted via phone (770) 963-5999.Contact Information
Primary practice address
650 Gwinnett Dr
Lawrenceville GA 30046-7439
Phone: (770) 963-5999
Fax: (770) 963-6603
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DN013673 | Georgia |
| Dental Providers / General Practice | 1223G0001X | 7427 | North Carolina |
Profile Details
| NPI number | 1093880288 |
|---|---|
| LBN Legal business name | Ebo, Ikechukwu P. |
| Credentials | D.D.S., P.A. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 22nd, 2006 |
| Last updated | Jul 1st, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093880288 | NPPES |
| North Carolina | MEDICAID | 89902F3 | |
| North Carolina | MEDICAID | 5901375 |
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