Provider Demographics
NPI:1932463932
Name:OGUNDIPE, OLUWATOYIN (DDS)
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:
Last Name:OGUNDIPE
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 1:5448 NATURE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2163
Mailing Address - Country:US
Mailing Address - Phone:917-968-7812
Mailing Address - Fax:
Practice Address - Street 1:5900 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2530
Practice Address - Country:US
Practice Address - Phone:757-644-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice