Provider Demographics
NPI:1295869766
Name:LADIPO, OMOWUMI
Entity type:Individual
Prefix:DR
First Name:OMOWUMI
Middle Name:
Last Name:LADIPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 ATASCOCITA RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4631
Mailing Address - Country:US
Mailing Address - Phone:281-446-0225
Mailing Address - Fax:281-271-8048
Practice Address - Street 1:3809 ATASCOCITA RD
Practice Address - Street 2:SUITE 700
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4631
Practice Address - Country:US
Practice Address - Phone:281-446-0225
Practice Address - Fax:281-271-8048
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1791394-03Medicaid
TX179139404Medicaid
TX1791394-02Medicaid
TX1791394-01Medicaid