Basic Information
| Provider Information | |||||||||
| NPI: | 1073633996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANAKO-OKEREKE | ||||||||
| FirstName: | UDUAK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023683922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178253400 | ||||||||
| FaxNumber: | 6178257217 | ||||||||
| Practice Location | |||||||||
| Address1: | 632 BLUE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021213213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178253400 | ||||||||
| FaxNumber: | 6178257217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 17717 | MA | Y | Dental Providers | Dentist | General Practice |
No ID Information.