Provider Demographics
NPI:1972837466
Name:DADA, AYOOLA
Entity Type:Individual
Prefix:
First Name:AYOOLA
Middle Name:
Last Name:DADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8232
Mailing Address - Country:US
Mailing Address - Phone:469-454-1470
Mailing Address - Fax:214-988-1049
Practice Address - Street 1:2805 S LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-8232
Practice Address - Country:US
Practice Address - Phone:469-454-1470
Practice Address - Fax:214-988-1049
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health