Provider Demographics
NPI:1124036173
Name:JEBODA, OLULEKE S (DMD,)
Entity Type:Individual
Prefix:DR
First Name:OLULEKE
Middle Name:S
Last Name:JEBODA
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 1:3616 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5629
Mailing Address - Country:US
Mailing Address - Phone:217-374-7100
Mailing Address - Fax:
Practice Address - Street 1:3616 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5629
Practice Address - Country:US
Practice Address - Phone:214-374-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice