Provider Demographics
NPI:1407415870
Name:OGUNRINDE, BOLADE (DMD)
Entity Type:Individual
Prefix:
First Name:BOLADE
Middle Name:
Last Name:OGUNRINDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17214 QUIET COVEY CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-6156
Mailing Address - Country:US
Mailing Address - Phone:516-800-5134
Mailing Address - Fax:
Practice Address - Street 1:329 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5028
Practice Address - Country:US
Practice Address - Phone:281-414-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice