Individual
DR. IKECHUKWU P. EBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.A.
Contact information
Practice address
650 GWINNETT DR, LAWRENCEVILLE, GA 30046-7439
(770) 963-5999
(770) 963-6603
Mailing address
650 GWINNETT DR., LAWRENCEVILLE, GA 30045
(770) 963-5999
(770) 963-6603
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013673
GA
1223G0001X
General Practice Dentistry
7427
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901375
—
NC
05
—
89902F3
—
NC
Enumeration date
11/22/2006
Last updated
07/01/2011
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