Healthcare Provider Details

I. General information

NPI: 1508771361
Provider Name (Legal Business Name): FHL DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 SALEM AVE
ROLLA MO
65401-3466
US

IV. Provider business mailing address

713 SALEM AVE
ROLLA MO
65401-3466
US

V. Phone/Fax

Practice location:
  • Phone: 573-368-7325
  • Fax:
Mailing address:
  • Phone: 573-368-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUWADAMILOLA ADETAYO
Title or Position: DR
Credential: DMD
Phone: 347-357-5090