Provider Demographics
NPI:1831207240
Name:ALADE, ENOMA (DDS MPH)
Entity type:Individual
Prefix:
First Name:ENOMA
Middle Name:
Last Name:ALADE
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 NORTH AZUSA AVENUE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702
Mailing Address - Country:US
Mailing Address - Phone:626-334-7310
Mailing Address - Fax:626-334-7311
Practice Address - Street 1:706 NORTH AZUSA AVENUE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702
Practice Address - Country:US
Practice Address - Phone:626-334-7310
Practice Address - Fax:626-334-7311
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG933866-01Medicaid