Healthcare Provider Details

I. General information

NPI: 1558243477
Provider Name (Legal Business Name): ABIMBOLA M OLADAYO BDS,MPH,MS,PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PARK AVE
SAINT LOUIS MO
63104-3024
US

IV. Provider business mailing address

50 COOK DR APT 5208
VALLEY PARK MO
63088-1611
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-2700
  • Fax:
Mailing address:
  • Phone: 601-310-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2025004557
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: