Provider Demographics
NPI:1013524461
Name:OLUWADARA DENTAL CORPORATION
Entity Type:Organization
Organization Name:OLUWADARA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWADAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLUWADARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-954-6377
Mailing Address - Street 1:9612 FOOTHILL BLVD STE 100&105
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3547
Mailing Address - Country:US
Mailing Address - Phone:909-939-5569
Mailing Address - Fax:210-579-6484
Practice Address - Street 1:9612 FOOTHILL BLVD STE 100&105
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3547
Practice Address - Country:US
Practice Address - Phone:909-939-5569
Practice Address - Fax:210-579-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty