Provider Demographics
NPI:1811362320
Name:RED OAKS DENTAL, PC
Entity Type:Organization
Organization Name:RED OAKS DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNSEWE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-462-2727
Mailing Address - Street 1:35 LAGRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2410
Mailing Address - Country:US
Mailing Address - Phone:845-462-2727
Mailing Address - Fax:845-462-2644
Practice Address - Street 1:35 LAGRANGE AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2410
Practice Address - Country:US
Practice Address - Phone:845-462-2727
Practice Address - Fax:845-462-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty