Provider Demographics
NPI:1801626072
Name:AWOFALA, OLUDAMILOLA (DMD)
Entity type:Individual
Prefix:DR
First Name:OLUDAMILOLA
Middle Name:
Last Name:AWOFALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 N SEWARDS CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3950
Mailing Address - Country:US
Mailing Address - Phone:857-206-9171
Mailing Address - Fax:
Practice Address - Street 1:1264 E JOPPA RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5825
Practice Address - Country:US
Practice Address - Phone:410-842-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD183061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice