Provider Demographics
NPI:1790241891
Name:SERIKI, OLUTOSIN OLARINDE (DDS)
Entity Type:Individual
Prefix:
First Name:OLUTOSIN
Middle Name:OLARINDE
Last Name:SERIKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5605
Mailing Address - Country:US
Mailing Address - Phone:214-629-4412
Mailing Address - Fax:
Practice Address - Street 1:12770 MERIT DR STE 850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1438
Practice Address - Country:US
Practice Address - Phone:972-361-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty