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NPI Code Detail

MEDICARE: O.I. OKUNUGA, DDS, P.C.

MEDICARE: O.I. OKUNUGA, DDS, P.C.
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
1122300000XDentist

General Provider Information

NPI Number : 1629549829
Entity Type Code : Organization
Provider Name (Legal Business Name) : O.I. OKUNUGA, DDS, P.C.
Provider Business Mailing Address
First Line : 11846 PERDUE SPRINGS CT
Second Line :
City : CHESTER
State : VA
Zip : 23831-2164
Country : US
Telephone Number : 804-748-4546
Fax Number :
Provider Business Practice Location Address
First Line : 11846 PERDUE SPRINGS CT
Second Line :
City : CHESTER
State : VA
Zip : 23831-2164
Country : US
Telephone Number : 804-748-4546
Fax Number :
Authorized Official
Title or Position : OWNER
Name : OLALEKAN OKUNUGA
Credential : DDS
Telephone Number : 804-748-4546
Provider Enumeration Date : 12/16/2018
Last Update Date : 12/16/2018

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