Provider Demographics
NPI:1811124969
Name:OBEBE, AKINDEKO D (DMD)
Entity type:Individual
Prefix:DR
First Name:AKINDEKO
Middle Name:D
Last Name:OBEBE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 VERNON AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2485
Mailing Address - Country:US
Mailing Address - Phone:216-849-8097
Mailing Address - Fax:
Practice Address - Street 1:525 PLEASANT HOME RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3525
Practice Address - Country:US
Practice Address - Phone:706-860-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL59011223P0221X
DEG100012971223P0221X
PADS0378481223P0221X
GADN0144251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry