Provider Demographics
NPI:1245543438
Name:TAIWO, ADENIKE P (DMD)
Entity type:Individual
Prefix:DR
First Name:ADENIKE
Middle Name:P
Last Name:TAIWO
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 1:1200 PALUXY MEDICAL CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5696
Mailing Address - Country:US
Mailing Address - Phone:817-573-8338
Mailing Address - Fax:
Practice Address - Street 1:5021 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6121
Practice Address - Country:US
Practice Address - Phone:352-371-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187981223G0001X
TX32682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice