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General NPI Number Information
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NPI Number | 1396123352
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Entity Type | Individual
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Provider Name | OLUWOLE OLUBUNMI FADAHUNSI DMD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 7611 LITTLE RIVER TPKE STE 101E
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City | ANNANDALE
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State | VA
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Zip | 22003-2630
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Country | US
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Telephone | 703-634-4195
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Fax |
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Provider Business Mailing Address
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Address Line | 7611 LITTLE RIVER TPKE STE 101E
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City | ANNANDALE
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State | VA
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Zip | 22003-2630
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Country | US
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Telephone | 703-634-4195
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 16193
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN1001975
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2019016472
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19032524
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401416435
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License Number State | VA
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