Provider Demographics
NPI:1003015629
Name:ADEFUNMILOLA TINUADE ORIOLA DENTAL CORPORATION
Entity Type:Organization
Organization Name:ADEFUNMILOLA TINUADE ORIOLA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEFUNMILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-881-7231
Mailing Address - Street 1:1909 N WATERMAN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1909 N WATERMAN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4842
Practice Address - Country:US
Practice Address - Phone:909-881-7231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51834261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental