Provider Demographics
NPI:1487711818
Name:OGUNSOLA, TAYO (BDS,DMD)
Entity type:Individual
Prefix:DR
First Name:TAYO
Middle Name:
Last Name:OGUNSOLA
Suffix:
Gender:M
Credentials:BDS,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CAMDEN WAY
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8460
Mailing Address - Country:US
Mailing Address - Phone:214-477-8661
Mailing Address - Fax:
Practice Address - Street 1:6500 PRESTON RD
Practice Address - Street 2:SUITE #203
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5856
Practice Address - Country:US
Practice Address - Phone:214-436-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice