Provider Demographics
NPI:1790500239
Name:EDUN, DAMILOLA (DDS)
Entity type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:
Last Name:EDUN
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 1:204-306 CROSSBOW STREET
Mailing Address - Street 2:
Mailing Address - City:THUNDERBAY
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:P7G1C3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 CROSSBOW STREET
Practice Address - Street 2:204
Practice Address - City:THUNDERBAY
Practice Address - State:ONTARIO
Practice Address - Zip Code:P7G1C3
Practice Address - Country:CA
Practice Address - Phone:807-357-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist