Provider Demographics
NPI:1457664831
Name:AJAJA, MOYOSOLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOYOSOLA
Middle Name:
Last Name:AJAJA
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 1:3555 MURPHY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-5212
Mailing Address - Country:US
Mailing Address - Phone:972-424-3555
Mailing Address - Fax:
Practice Address - Street 1:3555 MURPHY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-5212
Practice Address - Country:US
Practice Address - Phone:972-424-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice