Healthcare Provider Details

I. General information

NPI: 1962827196
Provider Name (Legal Business Name): ADERONKE OGUNBAMERU D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADERONKE ADEBAYO-DADA PEDIATRIC DENTIST

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 MATLOCK RD STE 208
ARLINGTON TX
76015-3600
US

IV. Provider business mailing address

3602 MATLOCK RD STE 208
ARLINGTON TX
76015-3600
US

V. Phone/Fax

Practice location:
  • Phone: 817-465-1888
  • Fax:
Mailing address:
  • Phone: 817-465-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberHAD 78
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15672
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number39047
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: