Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12011817A | IN |
NPI | 1598026270 |
---|---|
Provider Name | Dr. Olubunmi Adekugbe |
First Address | Merrillville, IN 46410-5556 |
Second Address | Merrillville, IN 46410-5556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 15/07/2013 |