Provider Demographics
NPI:1275392243
Name:OBASEKI, JOSEPHINE EVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:EVA
Last Name:OBASEKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPHINE
Other - Middle Name:EVA
Other - Last Name:ILEVBARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8808 9 STREET
Mailing Address - Street 2:
Mailing Address - City:DAWSON CREEK
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V1G0A8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2535 JORIE LN NE STE 104
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4137
Practice Address - Country:US
Practice Address - Phone:503-463-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist