Provider Demographics
NPI:1235366261
Name:OKUGBAYE, ESEOGHENE ERHUVWUYOMA (DDS)
Entity Type:Individual
Prefix:
First Name:ESEOGHENE
Middle Name:ERHUVWUYOMA
Last Name:OKUGBAYE
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 1:905 N CUMMINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-3258
Mailing Address - Country:US
Mailing Address - Phone:678-698-1440
Mailing Address - Fax:
Practice Address - Street 1:905 N CUMMINGS DR
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-3258
Practice Address - Country:US
Practice Address - Phone:678-698-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855156122300000X
TX26223122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist