Healthcare Provider Details

I. General information

NPI: 1154990307
Provider Name (Legal Business Name): OLUFUNKE OYINLOLA GBADAMOSI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 AIRPORT BLVD
PENSACOLA FL
32504-8607
US

IV. Provider business mailing address

11271 NW 7TH ST APT 11
MIAMI FL
33172-6505
US

V. Phone/Fax

Practice location:
  • Phone: 850-466-4133
  • Fax:
Mailing address:
  • Phone: 702-937-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN26071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: