Provider Demographics
NPI:1699376350
Name:FUNTO AYANLEKE DDS
Entity Type:Organization
Organization Name:FUNTO AYANLEKE DDS
Other - Org Name:FUNTO AYANLEKE DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FUNTO
Authorized Official - Middle Name:B
Authorized Official - Last Name:AYANLEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-333-2554
Mailing Address - Street 1:1116 W TOKAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3852
Mailing Address - Country:US
Mailing Address - Phone:209-333-2554
Mailing Address - Fax:
Practice Address - Street 1:1116 W TOKAY ST STE A
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3852
Practice Address - Country:US
Practice Address - Phone:209-333-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-07
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental