Active NPI
Oluwabusayo Lana, DDS
- General Practice Dentistry
- Glenn Dale, MD
National Provider Identifier
1215496047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17090
- Practice address
- 12150 Annapolis Rd
Glenn Dale, MD 20769-9183 - Phone
- (301) 249-8000
- NPI assigned
- Mar 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 17090 | MD | Primary |
Addresses
Primary practice location
12150 Annapolis Rd
Glenn Dale, MD 20769-9183
Mailing address
607 Sandy Ridge Dr
Glen Burnie, MD 21061-2084
Phone (443) 306-3525
Other practice location 1
111 E 210th St
Bronx, NY 10467-2401
Phone (888) 700-6623
Other practice location 2
40C E Ordnance Rd
Glen Burnie, MD 21060-6544
Phone (443) 713-4034
Other practice location 3
2300 Garrison Blvd Ste 209
Baltimore, MD 21216-2309
Phone (410) 947-0606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17090 | MD | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668556800000",
"number": "1215496047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "607 SANDY RIDGE DR",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210612084",
"telephone_number": "443-306-3525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12150 ANNAPOLIS RD",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699183",
"telephone_number": "301-249-8000"
}
],
"practiceLocations": [
{
"address_1": "111 E 210th St",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "104672401",
"country_code": "US",
"telephone_number": "888-700-6623",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "40C E Ordnance Rd",
"address_purpose": "LOCATION",
"city": "Glen Burnie",
"state": "MD",
"postal_code": "210606544",
"country_code": "US",
"telephone_number": "443-713-4034",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2300 Garrison Blvd Ste 209",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "212162309",
"country_code": "US",
"telephone_number": "410-947-0606",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LANA",
"first_name": "OLUWABUSAYO",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-19",
"last_updated": "2022-11-16",
"certification_date": "2022-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "17090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenn Dale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.