Healthcare Provider Details

I. General information

NPI: 1245469121
Provider Name (Legal Business Name): OLUBIYI OGUNJIMI DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 WINTHROP AVE
NORTH ANDOVER MA
01845-4289
US

IV. Provider business mailing address

111 MIDDLESEX TPKE # 1097
BURLINGTON MA
01803-4905
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-0040
  • Fax:
Mailing address:
  • Phone: 617-690-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: