Provider Demographics
NPI:1225562366
Name:OKETADE, SADIQ (DDS)
Entity type:Individual
Prefix:DR
First Name:SADIQ
Middle Name:
Last Name:OKETADE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 ERNEST W BARRETT PKWY NW SPC 150
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4984
Mailing Address - Country:US
Mailing Address - Phone:770-783-0866
Mailing Address - Fax:
Practice Address - Street 1:667 ERNEST W BARRETT PKWY NW SPC 150
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4984
Practice Address - Country:US
Practice Address - Phone:770-783-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0156111223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0700XDental ProvidersDentistProsthodontics