Jacqueline Ijeoma Ojimba, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013852 Issued in GA

Practice address

104 N. Belair Road
Suite 102
Evans, GA 30809

Phone

(706) 504-4903

NPI assigned

Apr 17, 2006

Last updated

Dec 16, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Smile Now Dental Clinic

  • Health Maintenance Organization
  • Evans, GA
  • NPI 1295152833
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1073577912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N. BELAIR ROAD",
            "address_2": "SUITE 102",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "706-504-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N. BELAIR ROAD",
            "address_2": "SUITE 102",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "706-504-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OJIMBA",
        "first_name": "JACQUELINE",
        "middle_name": "IJEOMA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-17",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "50-050591",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003151205A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Colden O'Leary Jr., PH. D.
• Kyle H O'Neal
• Occupational Rehab Services
• Tori Odhiambo, DMD
• Krista Odom, OTR/L
• Deise Cruz Oliveira, DDS
• Oncology Rehab, LLC
• Tyler Richard Ormsby, APC
• Orthoatlanta, LLC
• Iris Aymee Ostolaza

• General Practice Dentistry in Evans, GA
• Providers in Evans, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.