Provider Demographics
NPI:1790061745
Name:MBAMALU, OBIANUJU RITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:OBIANUJU
Middle Name:RITA
Last Name:MBAMALU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11185 IHILANI WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7181
Mailing Address - Country:US
Mailing Address - Phone:973-758-5765
Mailing Address - Fax:
Practice Address - Street 1:11185 IHILANI WAY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-7181
Practice Address - Country:US
Practice Address - Phone:737-585-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024344001223E0200X
NY05569311223E0200X
FLDN257761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics