Provider Demographics
NPI:1881924769
Name:OLUWOLE AJAGBE, DDS, MS, PC
Entity type:Organization
Organization Name:OLUWOLE AJAGBE, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:202-239-7108
Mailing Address - Street 1:3636 16TH ST NW
Mailing Address - Street 2:SUITE AG 44
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1146
Mailing Address - Country:US
Mailing Address - Phone:202-239-7108
Mailing Address - Fax:
Practice Address - Street 1:3636 16TH ST NW
Practice Address - Street 2:SUITE AG 44
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1146
Practice Address - Country:US
Practice Address - Phone:202-239-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC52631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty