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Individual

OLUWADAMILOLA OMODELE AJAGBE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
44 SAINT CROIX TRL S STE 100, LAKELAND, MN 55043-9657
(651) 436-5177
Mailing address
2817 S COOPER ST APT 2311, ARLINGTON, TX 76015-2465

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13899
MN
1223G0001X
General Practice Dentistry
34948
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
34948
TEXAS BOARD OF DENTAL EXAMINERS
TX
01
D13899
MINNESOTA BOARD OF DENTISTRY
MN
Enumeration date
07/21/2017
Last updated
12/13/2024
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