Active NPI
Kelechi Ukaegbu
- Periodontics
- Dallas, TX
National Provider Identifier
1013682244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 40052
- Practice address
- 3302 Gaston Ave Dept of
Dallas, TX 75246-2013 - Phone
- (972) 799-6706
- NPI assigned
- Aug 10, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 40052 | TX | |
| Periodontics | 1223P0300X | 40052 | TX | Primary |
Addresses
Primary practice location
3302 Gaston Ave Dept of
Dallas, TX 75246-2013
Mailing address
1500 Jackson St Apt 802
Dallas, TX 75201-4926
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kelechi.ukaegbu@tamu.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40052 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696377600000",
"number": "1013682244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 JACKSON ST APT 802",
"city": "DALLAS",
"state": "TX",
"postal_code": "752014926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3302 GASTON AVE DEPT OF",
"city": "DALLAS",
"state": "TX",
"postal_code": "752462013",
"telephone_number": "972-799-6706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UKAEGBU",
"first_name": "KELECHI",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-10",
"last_updated": "2023-10-04",
"certification_date": "2023-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "40052",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "40052",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kelechi.ukaegbu@tamu.edu",
"affiliation": "N",
"address_1": "3302 Gaston Ave Dept Of",
"city": "Dallas",
"state": "TX",
"country_code": "US",
"postal_code": "752462013",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.