Provider Demographics
NPI:1013571595
Name:MASHA, OLAGOKE (DMD)
Entity Type:Individual
Prefix:
First Name:OLAGOKE
Middle Name:
Last Name:MASHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14414 MERGANSER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4633
Mailing Address - Country:US
Mailing Address - Phone:832-978-2649
Mailing Address - Fax:
Practice Address - Street 1:12609 S GESSNER RD STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2804
Practice Address - Country:US
Practice Address - Phone:832-978-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice