Individual
MOFOLUSARA O OGUNFUSIKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
9614 PENNSYLVANIA AVE, UPPER MARLBORO, MD 20772-3670
(301) 599-0404
(301) 599-0400
Mailing address
9614 MARLBORO PIKE, UPPER MARLBORO, MD 20772-3670
(301) 599-0404
(301) 599-0400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13036
MD
122300000X
Dentist
DEN1000990
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN1000990
DENTAL LICENSE
DC
Enumeration date
08/03/2006
Last updated
04/04/2017
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