Provider Demographics
NPI:1164634366
Name:ASEMOTA, EDUGIE (DDS)
Entity Type:Individual
Prefix:
First Name:EDUGIE
Middle Name:
Last Name:ASEMOTA
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 1:1600 E HILL ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3612
Mailing Address - Country:US
Mailing Address - Phone:800-635-6668
Mailing Address - Fax:562-424-9807
Practice Address - Street 1:1600 E HILL ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-3612
Practice Address - Country:US
Practice Address - Phone:800-635-6668
Practice Address - Fax:562-424-9807
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice