Provider Demographics
NPI:1528167202
Name:AKINYEMI, FOLASHADE OLABISI (DMD)
Entity type:Individual
Prefix:DR
First Name:FOLASHADE
Middle Name:OLABISI
Last Name:AKINYEMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 N TRACY BLVD
Mailing Address - Street 2:TRACY
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3445
Mailing Address - Country:US
Mailing Address - Phone:209-835-3821
Mailing Address - Fax:
Practice Address - Street 1:1419 N TRACY BLVD
Practice Address - Street 2:TRACY
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3445
Practice Address - Country:US
Practice Address - Phone:209-835-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice