Provider Demographics
NPI:1427156199
Name:ONIMISI, OLUBUKOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:OLUBUKOLA
Middle Name:
Last Name:ONIMISI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5615
Mailing Address - Country:US
Mailing Address - Phone:214-352-3368
Mailing Address - Fax:214-351-5829
Practice Address - Street 1:2679 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5615
Practice Address - Country:US
Practice Address - Phone:214-352-3368
Practice Address - Fax:214-351-5829
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice