Healthcare Provider Details

I. General information

NPI: 1861765562
Provider Name (Legal Business Name): ADEYINKA ANYAEGBU D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 02/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 S HAMPTON RD STE 103
DALLAS TX
75232-1061
US

IV. Provider business mailing address

912 RAINBOW LN
CEDAR HILL TX
75104-3122
US

V. Phone/Fax

Practice location:
  • Phone: 214-943-1311
  • Fax:
Mailing address:
  • Phone: 202-615-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: