Provider Demographics
NPI:1245528686
Name:ATANDA, OLAMIDE OSUNDOLU (DMD)
Entity type:Individual
Prefix:DR
First Name:OLAMIDE
Middle Name:OSUNDOLU
Last Name:ATANDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 NW 27TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2826
Mailing Address - Country:US
Mailing Address - Phone:305-805-1700
Mailing Address - Fax:305-805-1715
Practice Address - Street 1:5607 NW 27TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-2826
Practice Address - Country:US
Practice Address - Phone:305-637-6400
Practice Address - Fax:305-636-5155
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307341223P0221X
FLDN194671223P0300X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNPIOther1245528686