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Provider Information for 1588603971



DR. IFEANYI N. EZUNU DDS

Gender: MALE

Individual NPI: 1588603971

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1588603971
Enumeration Date 2006-06-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 6460 SPALDING DR SUITE C
NORCROSS, GA 30092-1805
United States

Phone: 770-263-8408 | Fax: 770-263-8954
View Map External Link
Primary Practice Address 6460 SPALDING DR SUITE C
NORCROSS, GA 30092-1805
United States

Phone: 770-263-8408 | Fax: 770-263-8954
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice GA 012240
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location