Oluwadayo O Oluwadara, MS, PHD, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

101235 Issued in CA

Practice address

9612 Foothill Blvd Ste 100
Rancho Cucamonga, CA 91730-3594

Phone

(909) 939-5569

Fax

(909) 354-3230

NPI assigned

Jul 8, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Doctor of Philosophy

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.

• Oluwadara Dental Corporation

  • Dentist
  • Rancho Cucamonga, CA
  • NPI 1013524461
  NPD Authorized official
• Shebah Dental PLLC

  • Dentist
  • Converse, TX
  • NPI 1629414941
  NPD Authorized official

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

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1184911240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9612 FOOTHILL BLVD STE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303594",
            "telephone_number": "909-939-5569",
            "fax_number": "909-354-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9612 FOOTHILL BLVD STE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303594",
            "telephone_number": "909-939-5569",
            "fax_number": "909-354-3230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 E US Highway 83",
            "address_purpose": "LOCATION",
            "city": "McAllen",
            "state": "TX",
            "postal_code": "785018818",
            "country_code": "US",
            "telephone_number": "956-994-0349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9160 Fm 78 Ste 1B",
            "address_purpose": "LOCATION",
            "city": "Converse",
            "state": "TX",
            "postal_code": "781092040",
            "country_code": "US",
            "telephone_number": "210-463-4650",
            "fax_number": "210-579-6484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLUWADARA",
        "first_name": "OLUWADAYO",
        "middle_name": "O",
        "credential": "MS, PHD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-08",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "27453",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101235",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6775-15",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284941617",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://api.opendental.com/fhir/v2",
            "affiliation": "N",
            "endpointDescription": "the use of econnectors",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "not applicable",
            "address_1": "9612 Foothill Blvd Ste 100",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917303594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kenneth A Olson, M.A., M.F.T.
• Maria Olson
• Nicole Cheri Olson, LEP
• Will Wayne Olson
• Oluwadara Dental Corporation
• Onc Mental Health Inc
• One Asterisk Consulting, Inc
• One Source Healing, Inc.
• One Stop Multi-Specialty Medical Group & Therapy, Inc.
• One Stop Multi-Specialty Medical Group, Inc.

• General Practice Dentistry in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.