Individual provider Active NPI

Chinyere Mabel Okoro, DDS

  • Dentist
  • Cleveland, TN
National Provider Identifier
1760827711
Registry record updated Apr 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9763 Issued in TN
Practice address
4335 Keith St NW
Cleveland, TN 37312-4818
Phone
(423) 479-5400
Fax
(423) 339-2228
NPI assigned
May 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9763 TN Primary
Dentist 122300000X 15594 MD

Addresses

Primary practice location

4335 Keith St NW
Cleveland, TN 37312-4818

Mailing address

4335 Keith St NW
Cleveland, TN 37312-4818
Phone (423) 479-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20160415002084 MD Order and Referring Only - DentistPractitioner - Dentist 7810295383

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15594MDMDClinical Social Worker
9763TNMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1367539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428710400000",
    "number": "1760827711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4335 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373124818",
            "telephone_number": "423-479-5400",
            "fax_number": "423-339-2228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4335 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373124818",
            "telephone_number": "423-479-5400",
            "fax_number": "423-339-2228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKORO",
        "first_name": "CHINYERE",
        "middle_name": "MABEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-03",
        "last_updated": "2015-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "9763",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "15594",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

Verify at the official NPI Registry.