Provider Demographics
NPI:1376211755
Name:AJAYI, OPEYEMI (DDS)
Entity Type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:
Last Name:AJAYI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W GLADE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5419
Mailing Address - Country:US
Mailing Address - Phone:817-358-2008
Mailing Address - Fax:
Practice Address - Street 1:100 HUDSON OAKS DR
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-4712
Practice Address - Country:US
Practice Address - Phone:817-717-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319.0226261223G0001X
TX38084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice