Provider Demographics
NPI:1548243249
Name:ALONGE, OLUSEGUN K (DDS)
Entity Type:Individual
Prefix:
First Name:OLUSEGUN
Middle Name:K
Last Name:ALONGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:624 MARY LAKE DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-3423
Practice Address - Country:US
Practice Address - Phone:979-846-2500
Practice Address - Fax:979-846-2530
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20289122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649265646OtherNPI CINIC B
TX154467801Medicaid
TX1821185299OtherNPI AGENCY
TX154467803Medicaid
TX1275620551OtherNPI CLINIC R
TX741715140OtherTAX ID
TX1821185299OtherNPI AGENCY
TX741715140OtherTAX ID