Provider Demographics
NPI:1063911923
Name:AJIBOYE, FAITH T
Entity type:Individual
Prefix:DR
First Name:FAITH
Middle Name:T
Last Name:AJIBOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:FAITH
Other - Middle Name:T
Other - Last Name:ADEWUSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST STE 3D
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0917
Mailing Address - Country:US
Mailing Address - Phone:617-773-9900
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS ST STE 3D
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0917
Practice Address - Country:US
Practice Address - Phone:617-773-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000081204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery