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General NPI Number Information
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NPI Number | 1548243249
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Entity Type | Individual
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Provider Name | OLUSEGUN K. ALONGE DDS
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 624 MARY LAKE DR
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City | BRYAN
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State | TX
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Zip | 77801-3423
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Country | US
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Telephone | 979-846-2500
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Fax | 979-846-2530
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Provider Business Mailing Address
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Address Line | 1500 UNIVERSITY DR E #100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2600
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Country | US
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Telephone | 979-846-1100
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Fax | 979-260-9390
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 20289
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20289
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License Number State | TX
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