Provider Demographics
NPI:1356534986
Name:OMILABU, ADETUTU MOBOLANLE (DDS)
Entity type:Individual
Prefix:
First Name:ADETUTU
Middle Name:MOBOLANLE
Last Name:OMILABU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 BEECHNUT ST
Mailing Address - Street 2:SUITE A110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-4351
Mailing Address - Country:US
Mailing Address - Phone:713-933-5341
Mailing Address - Fax:
Practice Address - Street 1:10925 BEECHNUT ST
Practice Address - Street 2:SUITE A110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-4351
Practice Address - Country:US
Practice Address - Phone:713-933-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice