Provider Demographics
NPI:1659972362
Name:OGUNDIPE, OLUROTIMI ADEDAPO (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLUROTIMI
Middle Name:ADEDAPO
Last Name:OGUNDIPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 CORLEE CRES
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7208
Mailing Address - Country:US
Mailing Address - Phone:202-460-2597
Mailing Address - Fax:
Practice Address - Street 1:4716 ILLINOIS RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5123
Practice Address - Country:US
Practice Address - Phone:260-432-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013992A122300000X
MI29016005641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice