Provider Demographics
NPI:1932621224
Name:OLUSADA, OLUBUNMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:
Last Name:OLUSADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20B KAI DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7269
Mailing Address - Country:US
Mailing Address - Phone:703-403-3701
Mailing Address - Fax:
Practice Address - Street 1:600 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-0428
Practice Address - Country:US
Practice Address - Phone:910-737-6457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC511571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice