Provider Demographics
NPI:1689752065
Name:OREMOSU, ADEBIYI ADEDAPO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADEBIYI
Middle Name:ADEDAPO
Last Name:OREMOSU
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 1:2935 BREEZEWOOD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5498
Mailing Address - Country:US
Mailing Address - Phone:910-483-3050
Mailing Address - Fax:910-483-1699
Practice Address - Street 1:2935 BREEZEWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5498
Practice Address - Country:US
Practice Address - Phone:910-483-3050
Practice Address - Fax:910-483-1699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903792Medicaid