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NPI Code Detail

MEDICARE: SHOLA DAVID ANIFOWOSE

MEDICARE: SHOLA DAVID ANIFOWOSE
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
1122300000XDentistDD4751NM

General Provider Information

NPI Number : 1922521475
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOLA DAVID ANIFOWOSE
Provider Business Mailing Address
First Line : 2050 E ALGONQUIN RD STE 610
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60173-4166
Country : US
Telephone Number : 888-988-4066
Fax Number :
Provider Business Practice Location Address
First Line : 2330 W PIERCE ST
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-3514
Country : US
Telephone Number : 888-988-4066
Fax Number : 888-988-4066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2017
Last Update Date : 07/17/2017

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Directions to “ SHOLA DAVID ANIFOWOSE ” Practice Location

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