Organization
BENEDICT OLUSOLA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVELLA L POWELL MBA (OFFICE MANAGER)
(972) 228-3677
Entity
Organization
Contact information
Practice address
1700 N HAMPTON RD, STE 100, DESOTO, TX 75115-2392
(972) 228-3677
(972) 228-3672
Mailing address
PO BOX 628, DESOTO, TX 75115-8302
(972) 228-3677
(972) 228-3672
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/10/2006
Last updated
09/18/2012
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