MEDICARE: OLUSEGUN K. ALONGE 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	20289	TX
2	1223G0001X	General Practice Dentistry	20289	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649265646	OTHER	TX	NPI CINIC B
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1821185299	OTHER	TX	NPI AGENCY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1275620551	OTHER	TX	NPI CLINIC R
6	741715140	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1548243249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSEGUN K. ALONGE DDS

Provider Business Mailing Address
First Line	:	1500 UNIVERSITY DR E
Second Line	:	#100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-2600
Country	:	US
Telephone Number	:	979-846-1100
Fax Number	:	979-260-9390

Provider Business Practice Location Address
First Line	:	624 MARY LAKE DR
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-3423
Country	:	US
Telephone Number	:	979-846-2500
Fax Number	:	979-846-2530

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	06/20/2011

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Directions to “ OLUSEGUN K. ALONGE DDS” Practice Location

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