Provider Demographics
NPI:1891215273
Name:ADEYEYE, ABISOLUWA O (DDS)
Entity Type:Individual
Prefix:
First Name:ABISOLUWA
Middle Name:O
Last Name:ADEYEYE
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 1:4013 ROSWELL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3510
Mailing Address - Country:US
Mailing Address - Phone:240-441-9395
Mailing Address - Fax:
Practice Address - Street 1:2100 HEDGCOXE RD STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3103
Practice Address - Country:US
Practice Address - Phone:240-441-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017020498122300000X
TX350321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist