Provider Demographics
NPI:1790241891
Name:SERIKI, OLUTOSIN OLARINDE (DDS)
Entity type:Individual
Prefix:
First Name:OLUTOSIN
Middle Name:OLARINDE
Last Name:SERIKI
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 1:3711 EXCHANGE GLENWOOD PL UNIT 304
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4890
Mailing Address - Country:US
Mailing Address - Phone:214-629-4412
Mailing Address - Fax:
Practice Address - Street 1:515 DR CALVIN JONES HWY STE 120
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3159
Practice Address - Country:US
Practice Address - Phone:919-453-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348481223G0001X
NC139681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty