Provider Demographics
NPI:1598498784
Name:BANJO-AWOPEGBA, OLUWASEUN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLUWASEUN
Middle Name:P
Last Name:BANJO-AWOPEGBA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:OLUWASEUN
Other - Middle Name:PEROSOLA
Other - Last Name:BANJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:529 E 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1930
Mailing Address - Country:US
Mailing Address - Phone:443-562-3252
Mailing Address - Fax:
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1948
Practice Address - Country:US
Practice Address - Phone:844-796-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN2000185122300000X
390200000X
MD17837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program