Tabitha Ikpechukwu Efobi, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

1942552500 Issued in GA

Practice address

6570 Shallowford Rd
Lewisville, NC 27023-8651

Phone

(757) 831-6852

NPI assigned

Oct 8, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Locations

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

• Grace Pediatric Dental Care LLC

  • Dental Clinic/Center
  • Grayson, GA
  • NPI 1871258913
  NPD Authorized official

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1942552500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6570 SHALLOWFORD RD",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270238651",
            "telephone_number": "757-831-6852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6570 SHALLOWFORD RD",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270238651",
            "telephone_number": "757-831-6852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Spring St NW Ste 600",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303092870",
            "country_code": "US",
            "telephone_number": "757-831-6852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EFOBI",
        "first_name": "TABITHA",
        "middle_name": "IKPECHUKWU",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "9408",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "1942552500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Lee Cook, M.D.
• Nicholas Cornwell, DMD
• Tanya Depetris
• Aleesha L Dunham
• Eckerd Corporation
• Vanessa Fitzgerald
• Forsyth Memorial Hospital Inc
• Marie Adelfa Fuller Zurenda, COTA/L
• Teresa Lynn Funk, PHARM D
• Maria Guadalupe Garcia-Toledo, LPC

• Pediatric Dentistry in Lewisville, NC
• Providers in Lewisville, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; 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.