Provider Demographics
NPI:1689935520
Name:OMOLEHINWA, TEMITOPE T (BDS, DSCD)
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:T
Last Name:OMOLEHINWA
Suffix:
Gender:F
Credentials:BDS, DSCD
Other - Prefix:
Other - First Name:TEMITOPE
Other - Middle Name:T
Other - Last Name:ODUKOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS, DSCD
Mailing Address - Street 1:240 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6030
Mailing Address - Country:US
Mailing Address - Phone:215-898-6627
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-6176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARFD0000251223G0001X, 125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersOral Medicinist
No1223G0001XDental ProvidersDentistGeneral Practice