Provider Demographics
NPI:1659966265
Name:OYEGUNWA & ASSOCIATES IV, PLLC
Entity Type:Organization
Organization Name:OYEGUNWA & ASSOCIATES IV, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OYEGUNWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-729-6560
Mailing Address - Street 1:PO BOX 53556
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3556
Mailing Address - Country:US
Mailing Address - Phone:910-729-6560
Mailing Address - Fax:
Practice Address - Street 1:1916 SKIBO RD STE C5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1500
Practice Address - Country:US
Practice Address - Phone:888-617-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty