Provider Demographics
NPI:1174829576
Name:OGUNDELE, KEHINDE ADETORO (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEHINDE
Middle Name:ADETORO
Last Name:OGUNDELE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 CITY AVE
Mailing Address - Street 2:APT# 502
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1239
Mailing Address - Country:US
Mailing Address - Phone:818-675-4686
Mailing Address - Fax:
Practice Address - Street 1:4124 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4317
Practice Address - Country:US
Practice Address - Phone:904-733-3763
Practice Address - Fax:904-733-9783
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN222611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice