MEDICARE: SHOLA DAVID ANIFOWOSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD4751	NM

General Provider Information

NPI Number	:	1922521475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOLA DAVID ANIFOWOSE

Provider Business Mailing Address
First Line	:	2050 E ALGONQUIN RD STE 610
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-4166
Country	:	US
Telephone Number	:	888-988-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-3514
Country	:	US
Telephone Number	:	888-988-4066
Fax Number	:	888-988-4066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/17/2017

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Directions to “ SHOLA DAVID ANIFOWOSE ” Practice Location

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