Provider Demographics
NPI:1356527287
Name:A.A. OREMOSU, D.D.S., P.A.
Entity type:Organization
Organization Name:A.A. OREMOSU, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBIYI
Authorized Official - Middle Name:ADEDAPO
Authorized Official - Last Name:OREMOSU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-483-3050
Mailing Address - Street 1:PO BOX 40253
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0253
Mailing Address - Country:US
Mailing Address - Phone:910-483-3050
Mailing Address - Fax:910-222-8818
Practice Address - Street 1:2935 BREEZEWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5498
Practice Address - Country:US
Practice Address - Phone:910-483-3050
Practice Address - Fax:910-483-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908809Medicaid