Provider Demographics
NPI:1225124530
Name:IGUNBOLA, VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:IGUNBOLA
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 1:408 S GETTY ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5609
Mailing Address - Country:US
Mailing Address - Phone:830-278-5009
Mailing Address - Fax:830-278-3741
Practice Address - Street 1:408 S GETTY ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5609
Practice Address - Country:US
Practice Address - Phone:830-278-5009
Practice Address - Fax:830-278-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry