Provider Demographics
NPI:1417346909
Name:OJELEYE, JESUTOMI MERCY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUTOMI
Middle Name:MERCY
Last Name:OJELEYE
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 1:832 WASHINGTON AVE
Mailing Address - Street 2:APT F2
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2784
Mailing Address - Country:US
Mailing Address - Phone:785-248-1933
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4742
Practice Address - Country:US
Practice Address - Phone:785-248-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.29873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist