Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901022718 | MI |
N | 122300000X | Dentist | 33972 | TX |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2020029123 | MO |
N | 1223P0106X | Oral and Maxillofacial Pathology | 33972 | TX |
NPI | 1104302264 |
---|---|
Provider Name | Dr. Adepitan Owosho |
First Address | Kirksville, MO 63501-1443 |
Second Address | Kirksville, MO 63501-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 04/09/2020 |