Healthcare Provider Details

I. General information

NPI: 1295831170
Provider Name (Legal Business Name): TAIWO O. OGUNDIPE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4536 CHAMBLEE DUNWOODY RD SUITE 201
ATLANTA GA
30338-6200
US

IV. Provider business mailing address

4536 CHAMBLEE DUNWOODY RD SUITE 201
ATLANTA GA
30338-6200
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-8432
  • Fax: 678-990-9799
Mailing address:
  • Phone: 770-454-8432
  • Fax: 678-990-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN012670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: