Provider Demographics
NPI:1972290955
Name:AROWOSEGBE, SUSANNA OLUWADUNNI
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:OLUWADUNNI
Last Name:AROWOSEGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUSANNA
Other - Middle Name:OLUWADUNNI
Other - Last Name:OLOFINTUYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1132 ARBORETUM WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 TIMPANY BLVD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3451
Practice Address - Country:US
Practice Address - Phone:978-878-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL156181223G0001X
MADL158841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice