Provider Demographics
NPI:1285897256
Name:OLATUNBOSUN STAFFORD, SAOSAT MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SAOSAT
Middle Name:MARIA
Last Name:OLATUNBOSUN STAFFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAOSAT
Other - Middle Name:MARIA
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3704 W. CAMPWISDOM RD. STE. 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237
Mailing Address - Country:US
Mailing Address - Phone:972-709-4867
Mailing Address - Fax:214-594-7850
Practice Address - Street 1:3704 W. CAMPWISDOM RD. STE. 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:972-709-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193449941Medicaid