Provider Demographics
NPI:1558055319
Name:JOSEPHINE OGUNTIMEIN DENTAL OFFICE, PC
Entity Type:Organization
Organization Name:JOSEPHINE OGUNTIMEIN DENTAL OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNTIMEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-213-0396
Mailing Address - Street 1:4820 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4410
Mailing Address - Country:US
Mailing Address - Phone:202-829-3100
Mailing Address - Fax:
Practice Address - Street 1:4820 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4410
Practice Address - Country:US
Practice Address - Phone:202-829-3100
Practice Address - Fax:202-829-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental