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General NPI Number Information
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NPI Number | 1639701923
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Entity Type | Individual
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Provider Name | TIWALADE ABIDOYE DDS
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Gender | Female
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 1932 E SE LOOP 323
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City | TYLER
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State | TX
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Zip | 75701-8337
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Country | US
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Telephone | 430-205-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 430 E LAMAR BLVD STE 102
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City | ARLINGTON
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State | TX
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Zip | 76011-3600
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Country | US
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Telephone | 323-445-3465
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS104536
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License Number State | CA
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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 | 36272
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License Number State | TX
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