MEDICARE: OLUBUNMI AJIBOYE DDS

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
1	1223G0001X	General Practice Dentistry	DN014750	GA

General Provider Information

NPI Number	:	1205256039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUBUNMI AJIBOYE DDS

Provider Business Mailing Address
First Line	:	3485 ACWORTH DUE WEST RD NW STE 160
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-3870
Country	:	US
Telephone Number	:	678-961-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	3485 ACWORTH DUE WEST RD NW STE 160
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-3870
Country	:	US
Telephone Number	:	678-961-3370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2014
Last Update Date	:	02/24/2026

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