Provider Demographics
NPI:1285690636
Name:ADEWUMI, ABIMBOLA O (BDS, FDSRCS)
Entity Type:Individual
Prefix:DR
First Name:ABIMBOLA
Middle Name:O
Last Name:ADEWUMI
Suffix:
Gender:F
Credentials:BDS, FDSRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100405
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0405
Mailing Address - Country:US
Mailing Address - Phone:352-273-5800
Mailing Address - Fax:352-392-3070
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:D4-4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5800
Practice Address - Fax:352-392-3070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP 4371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBA 9055765OtherDEA