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General NPI Number Information
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NPI Number | 1699376350
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Entity Type | Organization
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Legal Business Name | FUNTO AYANLEKE DDS
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 1116 W TOKAY ST STE A
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City | LODI
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State | CA
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Zip | 95240-3852
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Country | US
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Telephone | 209-333-2554
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 W TOKAY ST STE A
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City | LODI
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State | CA
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Zip | 95240-3852
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Country | US
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Telephone | 209-333-2554
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FUNTO B AYANLEKE
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Credential |
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Telephone | 209-333-2554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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