Healthcare Provider Details

I. General information

NPI: 1831452648
Provider Name (Legal Business Name): IRENE EBUNOLUWA APATA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE EBUNOLUWA AYOOLA D.D.S

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 CROFTON CTR
CROFTON MD
21114-1343
US

IV. Provider business mailing address

9199 REISTERSTOWN RD STE 203A
OWINGS MILLS MD
21117-4514
US

V. Phone/Fax

Practice location:
  • Phone: 410-774-0221
  • Fax: 410-774-0251
Mailing address:
  • Phone: 410-356-8572
  • Fax: 410-356-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: