Provider Demographics
NPI:1861765562
Name:ANYAEGBU, ADEYINKA (DDS)
Entity type:Individual
Prefix:DR
First Name:ADEYINKA
Middle Name:
Last Name:ANYAEGBU
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 1:912 RAINBOW LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3122
Mailing Address - Country:US
Mailing Address - Phone:202-615-8634
Mailing Address - Fax:
Practice Address - Street 1:4650 S HAMPTON RD STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1061
Practice Address - Country:US
Practice Address - Phone:214-943-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist