Healthcare Provider Details

I. General information

NPI: 1609508191
Provider Name (Legal Business Name): TAIWO OLURO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 BROWN DR
BETHESDA MD
20889-5629
US

IV. Provider business mailing address

8960 BROWN DR
BETHESDA MD
20889-5629
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-0236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402205027
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: