Provider Demographics
NPI:1154920023
Name:DEJA OPUSUNJU DMD PLLC
Entity type:Organization
Organization Name:DEJA OPUSUNJU DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPUSUNJU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-810-2300
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77492-1138
Mailing Address - Country:US
Mailing Address - Phone:281-810-2300
Mailing Address - Fax:
Practice Address - Street 1:25031 WESTHEIMER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7317
Practice Address - Country:US
Practice Address - Phone:281-810-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental