Healthcare Provider Details

I. General information

NPI: 1598813172
Provider Name (Legal Business Name): OLUMIDE O OLAWOYE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DR SUITE 108
FLEMINGTON NJ
08822-4600
US

IV. Provider business mailing address

1100 WESCOTT DR SUITE 108
FLEMINGTON NJ
08822-4600
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6475
  • Fax: 908-788-6604
Mailing address:
  • Phone: 908-788-6475
  • Fax: 908-788-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02306100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS036703
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: