Provider Demographics
NPI:1023791407
Name:OLUFUNMILOLA AKINYEMI, DMD, PLLC
Entity type:Organization
Organization Name:OLUFUNMILOLA AKINYEMI, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFUNMILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-684-4740
Mailing Address - Street 1:2013 BLUE RANGE RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8487
Mailing Address - Country:US
Mailing Address - Phone:859-684-4740
Mailing Address - Fax:
Practice Address - Street 1:9609 E INDEPENDENCE BLVD STE V
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4670
Practice Address - Country:US
Practice Address - Phone:704-771-1544
Practice Address - Fax:704-771-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental