Provider Demographics
NPI:1811178171
Name:DADA-LAJUMOKE, ABIOLA ILEMOBOLA
Entity type:Individual
Prefix:MS
First Name:ABIOLA
Middle Name:ILEMOBOLA
Last Name:DADA-LAJUMOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 OAK LN
Mailing Address - Street 2:SUITE 224, PARC OAK PLAZA
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8812
Mailing Address - Country:US
Mailing Address - Phone:972-263-3808
Mailing Address - Fax:214-988-1049
Practice Address - Street 1:2304 OAK LN
Practice Address - Street 2:SUITE 224, PARC OAK PLAZA
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8812
Practice Address - Country:US
Practice Address - Phone:972-263-3808
Practice Address - Fax:214-988-1049
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0100062332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment