Provider Demographics
NPI:1962980284
Name:TOKEDE, OLUWATOSIN (DDS)
Entity type:Individual
Prefix:DR
First Name:OLUWATOSIN
Middle Name:
Last Name:TOKEDE
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 1:409 WOODKNOLL DR APT 803
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4926
Mailing Address - Country:US
Mailing Address - Phone:973-444-3784
Mailing Address - Fax:
Practice Address - Street 1:2909 COUNTY HOME RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5866
Practice Address - Country:US
Practice Address - Phone:973-444-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013018A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12013018AOtherINDIANA DENTAL BOARD