Healthcare Provider Details

I. General information

NPI: 1043131857
Provider Name (Legal Business Name): OGUNJIMI DENTAL HOLDINGS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BALLARDVALE ST
WILMINGTON MA
01887-1044
US

IV. Provider business mailing address

111 MIDDLESEX TPKE # 1097
BURLINGTON MA
01803-4905
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLUBIYI OGUNJIMI
Title or Position: OWNER
Credential: DDS
Phone: 617-690-8140