Individual
DR. EBOSETALE ODIAOGBE OKORUWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6936 PINE ARBOR DR S STE 230, COTTAGE GROVE, MN 55016-4645
(651) 204-5257
Mailing address
2052 IRENE ST, ROSEVILLE, MN 55113-6613
(712) 309-6588
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1002470
WI
122300000X
Dentist
Primary
D14478
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2018
Last updated
02/12/2024
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