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General NPI Number Information
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NPI Number | 1982396891
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Entity Type | Individual
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Provider Name | IYAYI OMOTESE AIGBOKHAN DMD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 3060 MITCHELLVILLE RD STE 108
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City | BOWIE
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State | MD
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Zip | 20716-3968
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Country | US
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Telephone | 301-218-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 10190 W LOS GATOS DR
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City | PEORIA
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State | AZ
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Zip | 85383-3552
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17938
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License Number State | MD
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