Provider Demographics
NPI:1932550944
Name:ADEBAYO, ADEDUNTAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADEDUNTAN
Middle Name:
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADEDUNTAN
Other - Middle Name:
Other - Last Name:BABARINDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1333 HARRIS WAY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3817
Mailing Address - Country:US
Mailing Address - Phone:646-595-9951
Mailing Address - Fax:
Practice Address - Street 1:3823 ROSWELL RD STE 203
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6295
Practice Address - Country:US
Practice Address - Phone:770-971-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0159871223X0400X
MADN18574281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty