Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 054771 | NY |
NPI | 1033440649 |
---|---|
Provider Name | Mr. Shina Odejimi |
First Address | Anadarko, OK 73005-0828 |
Second Address | Anadarko, OK 73005-0828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2010 |
Last Update Date | 14/12/2015 |