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General NPI Number Information
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NPI Number | 1568599926
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Entity Type | Organization
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Legal Business Name | TAIWO OSUNKOYA DMD LLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 414 N 6TH STREET
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City | DENTON
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State | MD
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Zip | 21629
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Country | US
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Telephone | 410-479-9466
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Fax | 410-479-9488
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | DENTON
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State | MD
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Zip | 21629
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Country | US
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Telephone | 410-479-9466
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Fax | 410-479-9488
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Authorized Official
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Title or Position | SOLO PRACTITIONER
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Name | DR. TAIWO MARY OSUNKOYA
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Credential | DMD
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Telephone | 410-479-9466
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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 | 12666
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License Number State | MD
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