Provider Demographics
NPI:1508418088
Name:OGUNYE, AYOMIDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AYOMIDE
Middle Name:
Last Name:OGUNYE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MIDE
Other - Middle Name:
Other - Last Name:OGUNYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7324 GASTON AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6159
Mailing Address - Country:US
Mailing Address - Phone:469-917-0418
Mailing Address - Fax:
Practice Address - Street 1:7324 GASTON AVE STE 121
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6159
Practice Address - Country:US
Practice Address - Phone:469-917-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361691223G0001X
TX36160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist