Provider Demographics
NPI:1073731048
Name:OSUNKOYA, TAIWO MARY (DMDLLC)
Entity Type:Individual
Prefix:
First Name:TAIWO
Middle Name:MARY
Last Name:OSUNKOYA
Suffix:
Gender:F
Credentials:DMDLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1356
Mailing Address - Country:US
Mailing Address - Phone:410-479-9466
Mailing Address - Fax:410-479-9488
Practice Address - Street 1:414 N 6TH ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1356
Practice Address - Country:US
Practice Address - Phone:410-479-9466
Practice Address - Fax:410-479-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0001159508Medicaid
DE0001159508Medicaid