Healthcare Provider Details

I. General information

NPI: 1750198107
Provider Name (Legal Business Name): OLALEKAN JAMES ONIJALA RDH, QOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10408 S RIDGEVIEW RD
OLATHE KS
66061-6438
US

IV. Provider business mailing address

1116 W WABASH ST
OLATHE KS
66061-3923
US

V. Phone/Fax

Practice location:
  • Phone: 913-390-3555
  • Fax:
Mailing address:
  • Phone: 316-641-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11382
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: