Provider Demographics
NPI:1215224456
Name:ADENUGA, OBAFEMI O (DDS)
Entity Type:Individual
Prefix:DR
First Name:OBAFEMI
Middle Name:O
Last Name:ADENUGA
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 1:931 S ERBY CAMPBELL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-5086
Mailing Address - Country:US
Mailing Address - Phone:972-635-3747
Mailing Address - Fax:469-518-4796
Practice Address - Street 1:931 S ERBY CAMPBELL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189
Practice Address - Country:US
Practice Address - Phone:972-635-3747
Practice Address - Fax:469-518-4796
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028744122300000X
TX333371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist