=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548950462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BLESSING ANU-OLUWAPO I-SALAMI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2023
-----------------------------------------------------
Last Update Date | 12/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THE DENTAL CENTER MISHAWAKA 112 IRONWORKS AVE B1
-----------------------------------------------------
City | MISHAWAKA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46544-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-255-4964
-----------------------------------------------------
Fax | 574-254-0012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | THE DENTAL CENTER MISHAWAKA 112 IRONWORKS AVE B1
-----------------------------------------------------
City | MISHAWAKA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46544-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-255-4964
-----------------------------------------------------
Fax | 574-254-0012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 12014276A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------