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General NPI Number Information
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NPI Number | 1245043496
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Entity Type | Individual
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Provider Name | ISAAC ADESOLA ADEGBOLA DDS
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Gender | Male
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 206 HIGH ST STE D
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City | ELLSWORTH
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State | ME
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Zip | 04605-1741
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Country | US
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Telephone | 207-669-4826
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Fax |
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Provider Business Mailing Address
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Address Line | 549 BRUNSWICK STREET
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City | YARMOUTH
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State | NS
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Zip | B5A 4N3
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN5203
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License Number State | ME
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