Individual
DR. IKENNA K OKONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4200 MORGANTON RD STE 304, FAYETTEVILLE, NC 28314-1564
(910) 488-0175
Mailing address
4200 MORGANTON RD STE 304, FAYETTEVILLE, NC 28314-1564
(910) 488-0175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11613
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11613
—
NC
Enumeration date
08/28/2019
Last updated
08/28/2019
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