Provider Demographics
NPI:1144215401
Name:OLUYEMISI LADITAN
Entity Type:Organization
Organization Name:OLUYEMISI LADITAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORROEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:661-945-2645
Mailing Address - Street 1:44810 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3106
Mailing Address - Country:US
Mailing Address - Phone:661-945-2645
Mailing Address - Fax:661-723-7718
Practice Address - Street 1:44810 ELM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3106
Practice Address - Country:US
Practice Address - Phone:661-945-2645
Practice Address - Fax:661-723-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44723-01OtherDENTICAL