Provider Demographics
NPI:1104200948
Name:AKINLUYI, FUNSHO AFOLUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FUNSHO
Middle Name:AFOLUKE
Last Name:AKINLUYI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3704
Mailing Address - Country:US
Mailing Address - Phone:320-774-2566
Mailing Address - Fax:
Practice Address - Street 1:4128 2ND ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3704
Practice Address - Country:US
Practice Address - Phone:320-774-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist