Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | F-24375 | TX |
Y | 1223G0001X | General Practice | 24375 | TX |
Y | 213EG0000X | General Practice | 24375 | TX |
NPI | 1427294438 |
---|---|
Provider Name | Dr. Iseoluwa Adebola Adedeji |
First Address | San Antonio, TX 78238-2443 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2008 |
Last Update Date | 18/06/2013 |