MEDICARE: ARUKAH PEDIATRIC DENTISTRY PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1962202135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARUKAH PEDIATRIC DENTISTRY PA

Provider Business Mailing Address
First Line	:	4553 N LOOP 1604 W STE 1211
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1365
Country	:	US
Telephone Number	:	210-306-4271
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 N LOOP 1604 W STE 1211
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1365
Country	:	US
Telephone Number	:	210-306-4271
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OMOLOLA A ADETONA
Credential	:	DDS
Telephone Number	:	210-885-0035

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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