Organization
FUNPEDOPARK LLC
Active
Other names
Fun Park Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLANREWAJU OYE-SOMEFUN DDS (PEDIATRIC DENTIST)
(757) 767-7275
Entity
Organization
Contact information
Practice address
1009 CENTERBROOKE LN STE 210, SUFFOLK, VA 23434-8664
(757) 767-7275
Mailing address
1009 CENTERBROOKE LN STE 210, SUFFOLK, VA 23434-8664
(757) 767-7275
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401416127
DENTAL LICENSE
VA
Enumeration date
02/06/2020
Last updated
09/16/2020
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