Provider Demographics
NPI:1568599926
Name:TAIWO OSUNKOYA DMD LLC
Entity Type:Organization
Organization Name:TAIWO OSUNKOYA DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:OSUNKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-479-9466
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-9466
Mailing Address - Fax:410-479-9488
Practice Address - Street 1:414 N 6TH STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-9466
Practice Address - Fax:410-479-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0001159508Medicaid