Provider Demographics
NPI:1831452648
Name:APATA, IRENE EBUNOLUWA (DDS)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:EBUNOLUWA
Last Name:APATA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IRENE
Other - Middle Name:EBUNOLUWA
Other - Last Name:AYOOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9199 REISTERSTOWN RD STE 203A
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4514
Mailing Address - Country:US
Mailing Address - Phone:410-356-8572
Mailing Address - Fax:410-356-8574
Practice Address - Street 1:1631 CROFTON CTR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1343
Practice Address - Country:US
Practice Address - Phone:410-774-0221
Practice Address - Fax:410-774-0251
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76904OtherCDS
MDD76904OtherCDS