Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS037453 | PA |
N | 1223G0001X | General Practice | 21294 | MA |
N | 213EG0000X | General Practice | 21294 | MA |
NPI | 1033314216 |
---|---|
Provider Name | Ibukun O Olagbemi |
First Address | Harrisburg, PA 17112-1900 |
Second Address | Harrisburg, PA 17112-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 03/07/2008 |