Provider Demographics
NPI:1144889551
Name:OGBUNWEZEH, DIAHANN SHOLA (DDS)
Entity type:Individual
Prefix:
First Name:DIAHANN
Middle Name:SHOLA
Last Name:OGBUNWEZEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9681 KAPLAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2048
Mailing Address - Country:US
Mailing Address - Phone:615-424-0790
Mailing Address - Fax:
Practice Address - Street 1:1315 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3730
Practice Address - Country:US
Practice Address - Phone:615-717-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23929122300000X
TN10930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist