Individual
DR. MODUPE MARY OGUNNUSI SOFUYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1290 E IRELAND RD, SOUTH BEND, IN 46614-3474
(574) 299-1400
Mailing address
823B SORIN ST, SOUTH BEND, IN 46617-2047
(786) 619-4170
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012973A
IN
Other
Enumeration date
06/30/2018
Last updated
06/30/2018
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