Virtue Ebohi Omere, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

39325 Issued in TX

Practice address

9139 Westover Hills Blvd Ste 105
San Antonio, TX 78251-2889

Phone

(210) 640-9457

NPI assigned

Mar 8, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Virtue Ebohi Akhidime Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Joyful Smiles Pediatric Dentistry and Braces

  • Pediatric Dentistry
  • San Antonio, TX
  • NPI 1629807730
  NPD Authorized official

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1982299236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9139 WESTOVER HILLS BLVD STE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782512889",
            "telephone_number": "940-208-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9139 WESTOVER HILLS BLVD STE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782512889",
            "telephone_number": "210-640-9457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMERE",
        "first_name": "VIRTUE",
        "middle_name": "EBOHI",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-08",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "39325",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "39325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIRTUE",
            "last_name": "AKHIDIME",
            "middle_name": "EBOHI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pediatric Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.