Provider Demographics
NPI:1982257325
Name:OYEBOLU, MOYOSOREOLUWA ADESOJI (DO)
Entity Type:Individual
Prefix:DR
First Name:MOYOSOREOLUWA
Middle Name:ADESOJI
Last Name:OYEBOLU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 S OMAR AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7535
Mailing Address - Country:US
Mailing Address - Phone:813-504-2527
Mailing Address - Fax:
Practice Address - Street 1:4031 ESTATE LA GRANDE PRINCESSE STE 33
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5213
Practice Address - Country:US
Practice Address - Phone:340-692-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI28381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice