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1499 E Marshall Ave Longview TX 75601-6814 | |
| (903) 242-9777 | |
| (903) 242-9778 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1499 E Marshall Ave, Longview, Texas |
| Authorized Official Name and Position | Omowumi Akhuini Ihionkhan (DENTIST/DIRECTOR) |
| Authorized Official Contact | 9032429777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1499 East Marshall Ave Longview TX 75601-5433 Ph: (903) 242-9777 | 1499 E Marshall Ave Longview TX 75601-6814 Ph: (903) 242-9777 |
| NPI Number | 1720269707 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 07/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720269707 | NPI | - | NPPES |
| 154847101 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20172 (Texas) | Primary |
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