Provider Demographics
NPI:1588070635
Name:ADELOYE, ISRAEL OREOLUWA ADEFUNMILAY (DMD)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:OREOLUWA ADEFUNMILAY
Last Name:ADELOYE
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:207-404-8039
Practice Address - Street 1:1048 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-404-8200
Practice Address - Fax:207-947-0435
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 1856595122300000X
MEDEN4429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist