Provider Demographics
NPI:1962827196
Name:OGUNBAMERU, ADERONKE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ADERONKE
Middle Name:
Last Name:OGUNBAMERU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:ADERONKE
Other - Middle Name:
Other - Last Name:ADEBAYO-DADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PEDIATRIC DENTIST
Mailing Address - Street 1:3602 MATLOCK RD STE 208
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3600
Mailing Address - Country:US
Mailing Address - Phone:817-465-1888
Mailing Address - Fax:
Practice Address - Street 1:3602 MATLOCK RD STE 208
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3600
Practice Address - Country:US
Practice Address - Phone:817-465-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHAD 781223D0001X
MD156721223G0001X
390200000X
TX390471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program