Provider Demographics
NPI:1407345457
Name:OSINUSI, OLAWALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLAWALE
Middle Name:
Last Name:OSINUSI
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 1:1436 WINFIELD DUNN PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-1582
Mailing Address - Country:US
Mailing Address - Phone:865-657-7645
Mailing Address - Fax:
Practice Address - Street 1:1436 WINFIELD DUNN PKWY STE 2
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37876-1582
Practice Address - Country:US
Practice Address - Phone:865-657-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN10662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program