1437489085 NPI number — DR. OLUWAKAYODE ADEBOLA OLOWOYO DDS

Table of content: DR. OLUWAKAYODE ADEBOLA OLOWOYO DDS (NPI 1437489085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437489085 NPI number — DR. OLUWAKAYODE ADEBOLA OLOWOYO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLOWOYO
Provider First Name:
OLUWAKAYODE
Provider Middle Name:
ADEBOLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1437489085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 WABASHA ST. S
Provider Second Line Business Mailing Address:
SUIT 202
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55107-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-293-8300
Provider Business Mailing Address Fax Number:
651-293-8130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 24TH AVE S
Provider Second Line Business Practice Location Address:
SUIT 202
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454-1455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-659-8689
Provider Business Practice Location Address Fax Number:
612-659-8690
Provider Enumeration Date:
01/04/2010

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: 1223G0001X , with the licence number:  D12656 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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