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General NPI Number Information
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NPI Number | 1598217069
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Entity Type | Individual
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Provider Name | ADETOLA ADENIYI D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 2801 S OLIVE ST STE 36C
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City | PINE BLUFF
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State | AR
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Zip | 71603-5413
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Country | US
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Telephone | 870-663-4180
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 N HALL ST APT 431
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City | DALLAS
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State | TX
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Zip | 75204-4199
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Country | US
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Telephone | 770-309-0708
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4220
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 32517
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN122657
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License Number State | GA
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