Healthcare Provider Details

I. General information

NPI: 1316705437
Provider Name (Legal Business Name): OLUJARE-ABIOLA LAWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SAINT PATRICKS DR
WALDORF MD
20603-4574
US

IV. Provider business mailing address

117 SAINT PATRICKS DR
WALDORF MD
20603-4574
US

V. Phone/Fax

Practice location:
  • Phone: 301-684-6754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18596
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: