Provider Demographics
NPI:1285919902
Name:MOMODU, KINGSLEY OISE (DDS)
Entity type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:OISE
Last Name:MOMODU
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 1:2901 BREEZEWOOD AVE STE 1011
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6040
Mailing Address - Country:US
Mailing Address - Phone:443-762-1987
Mailing Address - Fax:910-779-1099
Practice Address - Street 1:2901 BREEZEWOOD AVE STE 1011
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-6040
Practice Address - Country:US
Practice Address - Phone:443-762-1987
Practice Address - Fax:910-779-1099
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist