Individual provider · NPI-1

Oluwadamilola Adetayo, DMD

Dentist · Springfield, MO

NPI number1215779871
StatusActive
Last updated in NPPESJun 21, 2024

Details

NPI
1215779871
Entity type
Individual (NPI-1)
Name
Oluwadamilola Adetayo
Credential
DMD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 12, 2024
Certification date
Jun 21, 2024
Last updated
Jun 21, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist2024021944MOYes

Practice location

3842 S Glenstone Ave
Springfield, MO 65804-4418

Phone 417-719-1678

Mailing address

3842 S Glenstone Ave
Springfield, MO 65804-4418

Phone 417-719-1678

Other practice locations

2712 N Kansas Expy
Springfield, MO 65803-1106

Phone 417-895-9439

2712 N Kansas Expy
Springfield, MO 65803-1106

Phone 417-895-9439

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