Provider Demographics
NPI:1073804670
Name:OLUNWA, SUZETTA (DMD)
Entity Type:Individual
Prefix:
First Name:SUZETTA
Middle Name:
Last Name:OLUNWA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SUZETTA
Other - Middle Name:
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:201 S MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73128
Mailing Address - Country:US
Mailing Address - Phone:405-789-3750
Mailing Address - Fax:
Practice Address - Street 1:201 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73128-1006
Practice Address - Country:US
Practice Address - Phone:405-789-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6674122300000X
NY056112-1122300000X
TX30531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist