Provider Demographics
NPI:1669033189
Name:FADEYI, OPEYEMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:OPEYEMI
Middle Name:
Last Name:FADEYI
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 1:1807 MAGIC VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6947
Mailing Address - Country:US
Mailing Address - Phone:817-999-0587
Mailing Address - Fax:
Practice Address - Street 1:2771 E BROAD ST STE 221
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9157
Practice Address - Country:US
Practice Address - Phone:817-473-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360001223G0001X
OK1356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist