Provider Demographics
NPI:1639701923
Name:ABIDOYE, TIWALADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIWALADE
Middle Name:
Last Name:ABIDOYE
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 1:5135 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2893
Mailing Address - Country:US
Mailing Address - Phone:323-445-3465
Mailing Address - Fax:
Practice Address - Street 1:1932 E SE LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8337
Practice Address - Country:US
Practice Address - Phone:430-205-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1045361223G0001X
TX362721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice