Provider Demographics
NPI:1093336893
Name:ADEMIDUN, OLUDAMILOLA ADETOKUNBO (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLUDAMILOLA
Middle Name:ADETOKUNBO
Last Name:ADEMIDUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 CARTER ST APT 3002
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1387
Mailing Address - Country:US
Mailing Address - Phone:917-635-6312
Mailing Address - Fax:
Practice Address - Street 1:5754 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66202-2015
Practice Address - Country:US
Practice Address - Phone:913-671-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS617391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty