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General NPI Number Information
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NPI Number | 1649805664
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Entity Type | Individual
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Provider Name | ABIMBOLA OYINDAMOLA OYENIYI BDS, DMD, MSD,MSD
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Gender | Female
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 801 N 2ND ST FRNT 2
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3090
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Country | US
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Telephone | 267-296-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 2916 CLEARPOINT PL
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City | LOUISVILLE
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State | KY
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Zip | 40241-6516
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Country | US
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Telephone |
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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 | DS042915
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 10734
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS042915
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License Number State | PA
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