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NPI Code Detail

MEDICARE: OLUYEMISI LADITAN D.D.S

MEDICARE: OLUYEMISI LADITAN D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist25920TX
21223G0001XGeneral Practice Dentistry25920TX

General Provider Information

NPI Number : 1023215159
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUYEMISI LADITAN D.D.S
Provider Business Mailing Address
First Line : 308 S CESAR CHAVEZ AVE
Second Line :
City : CRYSTAL CITY
State : TX
Zip : 78839-4200
Country : US
Telephone Number : 830-374-2301
Fax Number : 830-374-9368
Provider Business Practice Location Address
First Line : 308 S CESAR CHAVEZ AVE
Second Line :
City : CRYSTAL CITY
State : TX
Zip : 78839-4200
Country : US
Telephone Number : 830-374-2301
Fax Number : 830-374-9368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2007
Last Update Date : 03/17/2018

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