Provider Demographics
NPI:1942434642
Name:OGUNTEBI, BAMIDURO REUBEN (DDS)
Entity Type:Individual
Prefix:
First Name:BAMIDURO
Middle Name:REUBEN
Last Name:OGUNTEBI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N. ARMENIA AVENUE
Mailing Address - Street 2:SUITE B.
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-254-0041
Mailing Address - Fax:813-253-8841
Practice Address - Street 1:110 N. ARMENIA AVENUE
Practice Address - Street 2:SUITE B.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-254-0041
Practice Address - Fax:813-253-8841
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13140122300000X, 1223E0200X
FL131401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist