Provider Demographics
NPI:1700267523
Name:AKINWANDE, KOLADE ADEOLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOLADE
Middle Name:ADEOLA
Last Name:AKINWANDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KOLADE
Other - Middle Name:ADEOLA
Other - Last Name:ADEROJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1708
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-576-1929
Practice Address - Street 1:1060 BRENTWOOD RD NE STE B-1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1052
Practice Address - Country:US
Practice Address - Phone:202-269-4746
Practice Address - Fax:202-269-6994
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415114122300000X
MD15992122300000X
DCDEN1001663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1700267523Medicaid
DCPENDINGMedicaid