Provider Demographics
NPI:1891006938
Name:OYEDIRAN, TOLULOPE OMOBONI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOLULOPE
Middle Name:OMOBONI
Last Name:OYEDIRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TOLULOPE
Other - Middle Name:OMOBONI
Other - Last Name:ADEFARATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1301 E US HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-8818
Mailing Address - Country:US
Mailing Address - Phone:956-994-0349
Mailing Address - Fax:956-994-0988
Practice Address - Street 1:2106 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8736
Practice Address - Country:US
Practice Address - Phone:956-366-4500
Practice Address - Fax:956-752-0706
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX318411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31841OtherDENTIST LICENSE