OLUTAYO A. ODUSANWO (NPI# 1821492505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821492505 |
| Entity Type | Individual |
| Full Name | OLUTAYO A. ODUSANWO |
| Credential | DMD |
| Practice Address |
335 Prairie Ave Providence RI 02905 |
| Mailing Address |
375 Allens Ave Providence RI 02905-5010 |
| Practice Telephone | 4014440430 |
| Practice Fax Number | 4014440489 |
| Mailing Telephone | 4014440400 |
| Mailing Fax Number | 4014440468 |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2019-07-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | DN1856580 | MA | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DEN03469 | RI | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 335 Prairie Ave, Providence, RI 02905 | 4014440430 | 4014440489 |
| Street Address |
335 PRAIRIE AVE |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548318884 | Melissa A Weintraub | Dentist | 335 Prairie Ave, Providence, RI 02905-2426 | 2007-01-05 |
| 1891309225 | Ethan Melillo | Pharmacist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-09-02 |
| 1215549910 | Jackie Habchi | Pharmacist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-08-24 |
| 1073125274 | Zachary Allen Armstrong | Pharmacist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-08-19 |
| 1598380610 | Megan E Lusignan | Optometrist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-06-15 |
| 1518431006 | Tiffany F Rea | Registered Nurse | 335 Prairie Ave, Providence, RI 02905-1924 | 2019-01-17 |
| 1184118127 | Erica Ann Knarr | Dentist | 335 Prairie Ave, Providence, RI 02905 | 2018-06-21 |
| 1336675768 | Valerie Marie Vorderstrasse | Psychologist | 335 Prairie Ave, Providence, RI 02905-1924 | 2017-05-04 |
| 1215478219 | The Providence Community Health Centers, Inc. | Clinic/Center | 335 Prairie Ave, Providence, RI 02905-1924 | 2017-03-10 |
| 1962959320 | Su Jin Bae | Dentist | 335 Prairie Ave, Providence, RI 02905-1924 | 2016-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477100808 | Raisa Emilia Garcia-diaz | Counselor | 66 Pavilion Avenue, Providence, RI 02905 | 2019-08-21 |
| 1962976571 | Nike A. Kendall | Social Worker | Program In Women's Oncology, 101 Dudley Street, Providence, RI 02905 | 2019-01-16 |
| 1891265443 | Carolyn Te Young | Pathology | 1320 Narragansett Blvd, Cranston, RI 02905 | 2018-11-27 |
| 1417427071 | Julianne Elizabeth Houtchens | Dietitian, Registered | Adult Primary Care 245 Chapman Street, Providence, RI 02905 | 2018-11-27 |
| 1922577394 | Dilenia C Cruz | Health Educator | 335r Prairie Ave., Suite 2b, Providence, RI 02905 | 2018-11-15 |
| 1639653116 | Varina S. Gunn | Health Educator | 335r Prarie Ave., Suite 2b, Providence, RI 02905 | 2018-09-20 |
| 1427590421 | Cardea Healthcare LLC | In Home Supportive Care | 100 Pavilion Avenue, Suite 101, Providence, RI 02905 | 2016-11-08 |
| 1265884597 | Maxwell King | Physical Therapy Assistant | 48 Moorland Avenue, Cranston, RI 02905 | 2016-07-11 |
| 1346698024 | Samantha Lea Colli | Physician Assistant | 100 Dudley St Fl 3, Providence, RI 02905 | 2016-06-02 |
| 1346697448 | Amy Jean Simpson | Marriage & Family Therapist | 1981 Broad Street, Cranston, RI 02905 | 2016-05-18 |
| Find all providers in zip 02905 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992119390 | Abc Pediatric Dentistry, PC | Dentist | 65 N Gateway Dr Ste 1, Providence, UT 84332-6102 | 2014-06-13 |
| 1457794315 | Kurt Gordon Vest | Dentist | 169 N Gateway Dr Ste 105, Providence, UT 84332-9861 | 2013-04-10 |
| 1275583874 | Farisa Surattanont Mulvey | Dentist | 148 Waterman St, Providence, RI 02906-2130 | 2006-05-12 |
| 1912963935 | Stanton Cannon Allen | Dentist | 65 N. Gateway Drive, Ste #1, Providence, UT 84332-6102 | 2006-04-26 |
| 1487216685 | Wasatch Pediatric Dentistry, PC | Dentist | 169 N Gateway Dr Ste 105, Providence, UT 84332-9861 | 2019-07-08 |
| 1902285190 | Brandon Nakken | Dentist | 65 N Gateway Dr Ste 1, Providence, UT 84332-6102 | 2015-05-21 |
| 1194165167 | Amir Yavari | Dentist | 21 Peace St, Providence, RI 02907 | 2013-07-05 |
| 1942565486 | Jeffrey W Higbee | Dentist | 21 Peace St, Providence, RI 02907-1510 | 2012-07-11 |
| 1871858233 | Derek Nobrega | Dentist | 21 Peace St, Providence, RI 02907-1510 | 2012-07-11 |
| 1427215656 | Douglas D Warner | Dentist | 21 Peace St, Providence, RI 02907-1510 | 2008-05-16 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02905 |
Please comment or provide details below to improve the information on OLUTAYO A. ODUSANWO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.