Healthcare Provider Details

I. General information

NPI: 1366793317
Provider Name (Legal Business Name): CAROLINE SOLA-SADE OGUNWARE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2012
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N LA CANADA DR
GREEN VALLEY AZ
85614-4379
US

IV. Provider business mailing address

1930 N LA CANADA DR
GREEN VALLEY AZ
85614-4379
US

V. Phone/Fax

Practice location:
  • Phone: 804-306-0011
  • Fax:
Mailing address:
  • Phone: 804-306-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008562
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: