Provider Demographics
NPI:1851859284
Name:OLADIPO, KRISTINE OLADAYO (DDS)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:OLADAYO
Last Name:OLADIPO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:OLADAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:12165 ELM ST
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1358
Practice Address - Country:US
Practice Address - Phone:410-651-5151
Practice Address - Fax:410-651-4256
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid