Individual
OLUWASANMI OLORUNTEBI ADEGBOYEGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1514 DOCTORS DR, BOSSIER CITY, LA 71111-3379
(318) 841-6023
Mailing address
1105 ISLAND PARK BLVD APT 801, SHREVEPORT, LA 71105-4770
(318) 780-0428
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7379
LA
Other
Enumeration date
06/17/2021
Last updated
09/15/2022
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