Provider Demographics
NPI:1366845539
Name:OLUTAYO OGUNSOLA
Entity Type:Organization
Organization Name:OLUTAYO OGUNSOLA
Other - Org Name:ABBA AESTHETIC SMILES AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUTAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-477-8661
Mailing Address - Street 1:6500 PRESTON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5857
Mailing Address - Country:US
Mailing Address - Phone:214-477-8661
Mailing Address - Fax:
Practice Address - Street 1:6500 PRESTON RD STE 203
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5857
Practice Address - Country:US
Practice Address - Phone:214-477-8661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty