Provider Demographics
NPI:1427294438
Name:ADEDEJI, ISEOLUWA ADEBOLA (BDS, MPH)
Entity type:Individual
Prefix:DR
First Name:ISEOLUWA
Middle Name:ADEBOLA
Last Name:ADEDEJI
Suffix:
Gender:F
Credentials:BDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 CARAWAY BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2443
Mailing Address - Country:US
Mailing Address - Phone:210-379-0044
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:UTHSCSA DEPARTMENT OF COMMUNITY DENTISTRY, MSC 7917
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-3200
Practice Address - Fax:210-567-4587
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-243751223D0001X
TX243751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health