Provider Demographics
NPI:1770745333
Name:OLA-JOHN, EBUN SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:EBUN
Middle Name:SUSAN
Last Name:OLA-JOHN
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 1:40 PITTS SCHOOL RD SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3931
Mailing Address - Country:US
Mailing Address - Phone:704-461-0707
Mailing Address - Fax:
Practice Address - Street 1:40 PITTS SCHOOL RD SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3931
Practice Address - Country:US
Practice Address - Phone:704-461-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027711122300000X
NC13521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist