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General NPI Number Information
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NPI Number | 1912251315
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Entity Type | Organization
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Legal Business Name | OLAJUMOKE ADEDOYIN, DDS OF LOUISIANA, A PROFESSIONAL DENTAL LLC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 9445 STEVENS RD STE 120
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City | SHREVEPORT
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State | LA
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Zip | 71106
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Country | US
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Telephone | 918-473-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 9445 STEVENS RD STE 120
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City | SHREVEPORT
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State | LA
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Zip | 71106
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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 | ENROLLMENT MANAGER
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Name | HALEY WOOSTER
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Credential |
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Telephone | 984-251-8846
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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 | 6219
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License Number State | LA
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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 |
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License Number State |
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