Healthcare Provider Details

I. General information

NPI: 1366299596
Provider Name (Legal Business Name): OMOYENI ESTHER OYEKOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST STE 113
LAUREL MD
20707-4335
US

IV. Provider business mailing address

1001 S GEORGE ST
YORK PA
17403-3676
US

V. Phone/Fax

Practice location:
  • Phone: 301-579-0132
  • Fax: 717-255-0957
Mailing address:
  • Phone: 717-851-2067
  • Fax: 717-255-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18507
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: