Healthcare Provider Details

I. General information

NPI: 1043379951
Provider Name (Legal Business Name): JOSEPHINE OLUNIKE OGUNTIMEIN D.D,S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 13TH ST NW
WASHINGTON DC
20011-4410
US

IV. Provider business mailing address

4820 13TH ST NW
WASHINGTON DC
20011-4410
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-3100
  • Fax: 202-829-3130
Mailing address:
  • Phone: 202-829-3100
  • Fax: 202-829-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5407
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5407
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: