Healthcare Provider Details

I. General information

NPI: 1720835994
Provider Name (Legal Business Name): GLORY OLUWABUKUNMI OGUNYINKA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N 10TH ST
FORT DODGE IA
50501-3915
US

IV. Provider business mailing address

126 N 10TH ST
FORT DODGE IA
50501-3915
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-6500
  • Fax:
Mailing address:
  • Phone: 515-576-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10541
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: