Provider Demographics
NPI:1629695978
Name:IGUN, OLAYINKA OLUWAYEMISI (DDS)
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:OLUWAYEMISI
Last Name:IGUN
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 1:3419 FONTENAY PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4745
Mailing Address - Country:US
Mailing Address - Phone:240-524-1580
Mailing Address - Fax:
Practice Address - Street 1:3419 FONTENAY PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4745
Practice Address - Country:US
Practice Address - Phone:240-524-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX372431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program