Healthcare Provider Details

I. General information

NPI: 1053152678
Provider Name (Legal Business Name): OLUWABUKOLA E. IBITOKUN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUWABUKOLA AWOLEYE

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335R PRAIRIE AVE
PROVIDENCE RI
02905-2426
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0422
  • Fax: 401-444-0427
Mailing address:
  • Phone: 401-444-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03782
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: