Provider Demographics
NPI:1396123352
Name:FADAHUNSI, OLUWOLE OLUBUNMI (DMD)
Entity type:Individual
Prefix:DR
First Name:OLUWOLE
Middle Name:OLUBUNMI
Last Name:FADAHUNSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 LITTLE RIVER TPKE STE 101E
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2630
Mailing Address - Country:US
Mailing Address - Phone:703-634-4195
Mailing Address - Fax:
Practice Address - Street 1:7611 LITTLE RIVER TPKE STE 101E
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2630
Practice Address - Country:US
Practice Address - Phone:703-634-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD161931223S0112X
DCDEN10019751223S0112X
MO20190164721223S0112X
IL190325241223S0112X
VA04014164351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery