Active NPI
Amenze Ighodaro, DDS
- General Practice Dentistry
- Texarkana, TX
National Provider Identifier
1215446547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 33542
- Practice address
- 2400 Richmond Rd
Texarkana, TX 75503-2466 - Phone
- (870) 330-4604
- NPI assigned
- Sep 29, 2017
- Last updated
- Sep 29, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 33542 | TX | Primary |
Addresses
Primary practice location
2400 Richmond Rd
Texarkana, TX 75503-2466
Mailing address
1200 Nimitz Way
Mesquite, TX 75181-4413
Phone (214) 469-7496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231020002910 | TX | Order and Referring Only - Dentist | 4486000817 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33542 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506643200000",
"number": "1215446547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 NIMITZ WAY",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751814413",
"telephone_number": "214-469-7496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 RICHMOND RD",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755032466",
"telephone_number": "870-330-4604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IGHODARO",
"first_name": "AMENZE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-29",
"last_updated": "2017-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "33542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
- Debbie Susan Ibrahim, MS,CCC-SLP
- Icare Pediatric & Adult Therapy LLC
- Icare Pro of Texas Aco Billing Professional Association
- Icarepro of Texas, PA
- Osakpanmwan Idahosa, PHARMD
- Independent Anesthesia of Texarkana, L.L.P
- Independent Living of Texarkana, LLC
- Independent Senior Living of Texarkana, LLC (Visiting Angels-Texarkana)
- Insight Behavioral Health PLLC
- Integracare of Athens - Hospice, LLC (Gentiva)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2017; 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.