1427294438 NPI number — DR. ISEOLUWA ADEBOLA ADEDEJI BDS, MPH

Table of content: DR. ISEOLUWA ADEBOLA ADEDEJI BDS, MPH (NPI 1427294438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427294438 NPI number — DR. ISEOLUWA ADEBOLA ADEDEJI BDS, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEDEJI
Provider First Name:
ISEOLUWA
Provider Middle Name:
ADEBOLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
BDS, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427294438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5637 CARAWAY BND
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78238-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-379-0044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7703 FLOYD CURL DR
Provider Second Line Business Practice Location Address:
UTHSCSA DEPARTMENT OF COMMUNITY DENTISTRY, MSC 7917
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-567-3200
Provider Business Practice Location Address Fax Number:
210-567-4587
Provider Enumeration Date:
12/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  F-24375 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 24375 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)