Provider Demographics
NPI:1952449944
Name:TEWOGBADE, ADESEGUN O (DMD)
Entity Type:Individual
Prefix:
First Name:ADESEGUN
Middle Name:O
Last Name:TEWOGBADE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3966 ANNISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6970
Mailing Address - Country:US
Mailing Address - Phone:770-469-4192
Mailing Address - Fax:770-469-4195
Practice Address - Street 1:3966 ANNISTOWN RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6970
Practice Address - Country:US
Practice Address - Phone:770-469-4192
Practice Address - Fax:770-469-4195
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0134001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry