Provider Demographics
NPI:1477535821
Name:ONIME, OLAKUNBI IBIRONKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLAKUNBI
Middle Name:IBIRONKE
Last Name:ONIME
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 1:6559 OLD JACKSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0720
Mailing Address - Country:US
Mailing Address - Phone:903-747-3839
Mailing Address - Fax:903-747-3842
Practice Address - Street 1:6559 OLD JACKSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0720
Practice Address - Country:US
Practice Address - Phone:903-747-3839
Practice Address - Fax:903-747-3842
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice