Healthcare Provider Details

I. General information

NPI: 1891006938
Provider Name (Legal Business Name): TOLULOPE OMOBONI OYEDIRAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOLULOPE OMOBONI ADEFARATI DDS

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 TREASURE HILLS BLVD
HARLINGEN TX
78550-8736
US

IV. Provider business mailing address

1301 E US HIGHWAY 83
MCALLEN TX
78501-8818
US

V. Phone/Fax

Practice location:
  • Phone: 956-366-4500
  • Fax: 956-752-0706
Mailing address:
  • Phone: 956-994-0349
  • Fax: 956-994-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: