Provider Demographics
NPI:1992680409
Name:BAMIGBOYE, SUNDAY ADEBARE
Entity type:Individual
Prefix:
First Name:SUNDAY
Middle Name:ADEBARE
Last Name:BAMIGBOYE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BRIGHTLEAF RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2456
Mailing Address - Country:US
Mailing Address - Phone:915-304-9467
Mailing Address - Fax:915-304-9467
Practice Address - Street 1:1027 HANES MALL BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1310
Practice Address - Country:US
Practice Address - Phone:743-249-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist