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General NPI Number Information
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NPI Number | 1790187128
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Entity Type | Organization
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Legal Business Name | OLALEKAN OKUNUGA, DDS, P.C.
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 1165 E ATLANTIC ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-9547
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Country | US
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Telephone | 434-447-2492
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Fax | 434-447-2873
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Provider Business Mailing Address
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Address Line | 1165 E ATLANTIC ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-9547
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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 | CREDENTIALING SPECIALIST
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Name | HALEY WOOSTER
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Credential |
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Telephone | 712-744-4529
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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 | 0401413867
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License Number State | VA
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