Healthcare Provider Details

I. General information

NPI: 1487711818
Provider Name (Legal Business Name): TAYO OGUNSOLA BDS,DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 PRESTON RD SUITE #203
FRISCO TX
75034-5856
US

IV. Provider business mailing address

811 CAMDEN WAY
PROSPER TX
75078-8460
US

V. Phone/Fax

Practice location:
  • Phone: 214-436-5400
  • Fax:
Mailing address:
  • Phone: 214-477-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: