Provider Demographics
NPI:1841577822
Name:OLADUBU, MICHAEL O (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:OLADUBU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:SUITE #2B-01
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-1361
Mailing Address - Fax:202-865-4849
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:SUITE #2B-01
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1361
Practice Address - Fax:202-865-4849
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401413897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program