MEDICARE: OMOYENI ESTHER OYEKOLA

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	18507	MD
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366299596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMOYENI ESTHER OYEKOLA

Provider Business Mailing Address
First Line	:	1001 S GEORGE ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-3676
Country	:	US
Telephone Number	:	717-851-2067
Fax Number	:	717-255-0957

Provider Business Practice Location Address
First Line	:	535 MAIN ST STE 113
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-4335
Country	:	US
Telephone Number	:	301-579-0132
Fax Number	:	717-255-0957

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

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	12/10/2025

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