Provider Demographics
NPI:1972081032
Name:AJALA, BISOLA (DMD)
Entity type:Individual
Prefix:DR
First Name:BISOLA
Middle Name:
Last Name:AJALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 AMHERST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3207
Mailing Address - Country:US
Mailing Address - Phone:713-490-8880
Mailing Address - Fax:281-417-4008
Practice Address - Street 1:6245 HIGHWAY 6 STE 400
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4765
Practice Address - Country:US
Practice Address - Phone:281-969-5099
Practice Address - Fax:281-969-7729
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041905122300000X
TX370131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist