Provider Demographics
NPI:1841468162
Name:OLUFEMI A. OGUNTOLU DMD PC
Entity type:Organization
Organization Name:OLUFEMI A. OGUNTOLU DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNTOLU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-286-1620
Mailing Address - Street 1:252 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4311
Mailing Address - Country:US
Mailing Address - Phone:781-286-1620
Mailing Address - Fax:781-289-7901
Practice Address - Street 1:252 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4311
Practice Address - Country:US
Practice Address - Phone:781-286-1620
Practice Address - Fax:781-289-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty