Provider Demographics
NPI:1598267239
Name:AJOSE-ADEOGUN, FOLARERA OLANIKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FOLARERA
Middle Name:OLANIKE
Last Name:AJOSE-ADEOGUN
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 1:6244 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-5032
Mailing Address - Country:US
Mailing Address - Phone:404-213-1200
Mailing Address - Fax:
Practice Address - Street 1:5005 RIVERSIDE DR UNIT A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1121
Practice Address - Country:US
Practice Address - Phone:478-284-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist