Provider Demographics
NPI:1104466457
Name:ENCINO FAMILY DENTISTRY, COSMETIC & IMPLANT DENTISTRY PLLC
Entity type:Organization
Organization Name:ENCINO FAMILY DENTISTRY, COSMETIC & IMPLANT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINTUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-503-0230
Mailing Address - Street 1:2339 E EVANS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2718
Mailing Address - Country:US
Mailing Address - Phone:210-503-0230
Mailing Address - Fax:
Practice Address - Street 1:2339 E EVANS RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2718
Practice Address - Country:US
Practice Address - Phone:210-503-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental