Provider Demographics
NPI:1245756675
Name:SIJUWADE, ADETUNJI ALABI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADETUNJI
Middle Name:ALABI
Last Name:SIJUWADE
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 1:1444 GRAND BLVD APT 1604
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2968
Mailing Address - Country:US
Mailing Address - Phone:213-222-5096
Mailing Address - Fax:
Practice Address - Street 1:15281 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5290
Practice Address - Country:US
Practice Address - Phone:913-353-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68151223G0001X
KS615521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice