MEDICARE: DR. SAOSAT MARIA OLATUNBOSUN STAFFORD 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	122300000X	Dentist	23931	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285897256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAOSAT MARIA OLATUNBOSUN STAFFORD DDS

Provider Business Mailing Address
First Line	:	3704 W. CAMPWISDOM RD. STE. 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237
Country	:	US
Telephone Number	:	972-709-4867
Fax Number	:	214-594-7850

Provider Business Practice Location Address
First Line	:	3704 W. CAMPWISDOM RD. STE. 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237
Country	:	US
Telephone Number	:	972-709-4867
Fax Number	:

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	03/30/2022

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