Provider Demographics
NPI:1467629048
Name:BUKOLA ODUYELU, DDS, PC
Entity type:Organization
Organization Name:BUKOLA ODUYELU, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUYELU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-563-2670
Mailing Address - Street 1:2264 LONDON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3903
Mailing Address - Country:US
Mailing Address - Phone:757-563-2670
Mailing Address - Fax:757-563-2851
Practice Address - Street 1:2264 LONDON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3903
Practice Address - Country:US
Practice Address - Phone:757-563-2670
Practice Address - Fax:757-563-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty