Provider Demographics
NPI:1740572841
Name:OGUNSANYA, OLUREMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLUREMI
Middle Name:
Last Name:OGUNSANYA
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 1:3273 PARKSIDE PL APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4931
Mailing Address - Country:US
Mailing Address - Phone:646-769-0555
Mailing Address - Fax:
Practice Address - Street 1:1610 E 19TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1375
Practice Address - Country:US
Practice Address - Phone:718-576-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058374-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery