=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285128017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IDOWU AKINTOKUNBO AKINYELE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2018
-----------------------------------------------------
Last Update Date | 10/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 E LAMAR ST
-----------------------------------------------------
City | ROYSE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75189-3921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-595-5355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 PACKSADDLE TRL
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-9469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-595-5355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 34017
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------