Provider Demographics
NPI:1447811666
Name:ULASI, CHIJIOKE IFEANYICHUKWU (DMD)
Entity type:Individual
Prefix:DR
First Name:CHIJIOKE
Middle Name:IFEANYICHUKWU
Last Name:ULASI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5886 SHADES RUN LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4110
Mailing Address - Country:US
Mailing Address - Phone:404-822-3533
Mailing Address - Fax:
Practice Address - Street 1:2731 ML KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5235
Practice Address - Country:US
Practice Address - Phone:205-349-3250
Practice Address - Fax:205-752-1517
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006675-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist