Provider Demographics
NPI:1356848022
Name:ADEGABI, OLUBUSOLA OLAOLUWA (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLUBUSOLA
Middle Name:OLAOLUWA
Last Name:ADEGABI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 LAUREL BOWIE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1712
Mailing Address - Country:US
Mailing Address - Phone:678-638-9856
Mailing Address - Fax:
Practice Address - Street 1:6911 LAUREL BOWIE RD STE 204
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1712
Practice Address - Country:US
Practice Address - Phone:678-638-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015756122300000X
VA0401416496122300000X
DCDEN1002080122300000X
MD16835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist