Provider Demographics
NPI:1154465714
Name:AJAGBE, OLUWOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLUWOLE
Middle Name:
Last Name:AJAGBE
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 1:3636 16TH ST NW
Mailing Address - Street 2:SUITE AG 64
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1146
Mailing Address - Country:US
Mailing Address - Phone:202-239-7108
Mailing Address - Fax:301-515-7491
Practice Address - Street 1:3636 16TH STREET NW
Practice Address - Street 2:SUITE AG 64
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-239-7108
Practice Address - Fax:301-515-7491
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016801200Medicaid