Provider Demographics
NPI:1376983908
Name:JOLAOSO, ISMAIL ADEYEMI (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:ADEYEMI
Last Name:JOLAOSO
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 E ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-9547
Mailing Address - Country:US
Mailing Address - Phone:434-447-2492
Mailing Address - Fax:434-447-2873
Practice Address - Street 1:1165 E ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-9547
Practice Address - Country:US
Practice Address - Phone:434-447-2492
Practice Address - Fax:434-447-2873
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014145511223D0001X, 122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health