Provider Demographics
NPI:1902520547
Name:AKINJISE, PETER O (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:O
Last Name:AKINJISE
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 1:1704 JUDIE LN APT C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-6733
Mailing Address - Country:US
Mailing Address - Phone:780-881-7029
Mailing Address - Fax:
Practice Address - Street 1:1704 JUDIE LN APT C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6733
Practice Address - Country:US
Practice Address - Phone:780-881-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0439071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice