Healthcare Provider Details

I. General information

NPI: 1649465089
Provider Name (Legal Business Name): AMIRA M OGUNLEYE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 NE 125TH ST SUITE 201
NORTH MIAMI FL
33161-5800
US

IV. Provider business mailing address

1075 NE 125TH ST SUITE 201
NORTH MIAMI FL
33161-5800
US

V. Phone/Fax

Practice location:
  • Phone: 305-899-7979
  • Fax: 305-899-2880
Mailing address:
  • Phone: 305-899-7979
  • Fax: 305-899-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.022640
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: