MEDICARE: DOMINIC OLADELE

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1790450351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC OLADELE

Provider Business Mailing Address
First Line	:	PO BOX 5673
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-0673
Country	:	US
Telephone Number	:	614-602-1079
Fax Number	:

Provider Business Practice Location Address
First Line	:	8385 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-1602
Country	:	US
Telephone Number	:	614-602-1079
Fax Number	:

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

Provider Enumeration Date	:	08/14/2021
Last Update Date	:	08/14/2021

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Directions to “ DOMINIC OLADELE ” Practice Location

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