Provider Demographics
NPI:1710378716
Name:FALAIYE, MOBOLAJI
Entity Type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:
Last Name:FALAIYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 OXON HILL RD STE 650
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3105
Mailing Address - Country:US
Mailing Address - Phone:301-766-8568
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 650
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3105
Practice Address - Country:US
Practice Address - Phone:301-766-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA040414158061223G0001X
MD163971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice