Oluwadamilola Omodele Ajagbe, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13899 Issued in MN

Practice address

44 Saint Croix TRL S Ste 100
Lakeland, MN 55043-9657

Phone

(651) 436-5177

NPI assigned

Jul 21, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northland Dental Partners, PLLC

  dba Metro Dentalcare Lakeland

  • General Practice Dentistry
  • Lakeland, MN
  • NPI 1568110997
  NPD
• Apple Tree Dental

  • General Practice Dentistry
  • Rochester, MN
  • NPI 1598924268
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1164945150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 S COOPER ST APT 2311",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 SAINT CROIX TRL S STE 100",
            "city": "LAKELAND",
            "state": "MN",
            "postal_code": "550439657",
            "telephone_number": "651-436-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAGBE",
        "first_name": "OLUWADAMILOLA",
        "middle_name": "OMODELE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-21",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "34948",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BOARD OF DENTISTRY",
            "identifier": "D13899",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF DENTAL EXAMINERS",
            "identifier": "34948",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adena LLC
• Advanced Medical LLC
• Afton Chiropractic Clinic
• Afton Chiropractic Clinic PA
• Alexander John Buechter, DC
• Jodie Lea Eian, D.C.
• Robin Lee Fate, M.S., LPCC
• Rosann Marie Froehle, D.C.
• Kirsten Golden, DC

• Dentist in Lakeland, MN
• Providers in Lakeland, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.