Provider Demographics
NPI:1326127713
Name:ADEPETU, ADEWALE OLAOLU (DDS)
Entity Type:Individual
Prefix:
First Name:ADEWALE
Middle Name:OLAOLU
Last Name:ADEPETU
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 1:686 E 234TH ST
Mailing Address - Street 2:APT. A-11
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2752
Mailing Address - Country:US
Mailing Address - Phone:718-496-7751
Mailing Address - Fax:
Practice Address - Street 1:754 E 151ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3267
Practice Address - Country:US
Practice Address - Phone:718-401-5431
Practice Address - Fax:718-993-4395
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051093-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist