Provider Demographics
NPI:1043379951
Name:OGUNTIMEIN, JOSEPHINE OLUNIKE (DD,S)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:OLUNIKE
Last Name:OGUNTIMEIN
Suffix:
Gender:F
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4410
Mailing Address - Country:US
Mailing Address - Phone:202-829-3100
Mailing Address - Fax:202-829-3130
Practice Address - Street 1:4820 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4410
Practice Address - Country:US
Practice Address - Phone:202-829-3100
Practice Address - Fax:202-829-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC54071223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty