=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164618054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA ONYEADOR D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2007
-----------------------------------------------------
Last Update Date | 07/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 W COMPTON BLVD SUITE 103
-----------------------------------------------------
City | COMPTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90220-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-762-9292
-----------------------------------------------------
Fax | 310-762-6680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 W COMPTON BLVD SUITE 103
-----------------------------------------------------
City | COMPTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90220-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-762-9292
-----------------------------------------------------
Fax | 310-762-6680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 47200
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------