Andrew Akindutire, DMD

Key facts

NPI

1104470368

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

36921 (TX)

Practice address

8214 FM-78
Suite 105
Converse, TX 78109

Phone

(210) 920-4963

NPI assigned

Jul 26, 2019

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Light Family Dental and Implant Dentistry PLLC General Practice Dentistry · Converse, TX · NPI 1912617929
  Medicare reassignment NPD Authorized official GENERAL PRACTICE · TX

Medicare participation

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 2, 2022.

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1104470368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8214 FM-78",
            "address_2": "SUITE 105",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781098944",
            "telephone_number": "210-920-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8214 FM-78",
            "address_2": "SUITE 105",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "78109",
            "telephone_number": "210-920-4963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3101 Oak Groove Rd.",
            "address_2": "Suite 6",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "63901",
            "country_code": "US",
            "telephone_number": "573-840-3013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AKINDUTIRE",
        "first_name": "ANDREW",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-26",
        "last_updated": "2022-12-02",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Converse, TX · General Practice Dentistry in Texas