Kingsley Oise Momodu, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

9234 Issued in NC

Practice address

2901 Breezewood Ave Ste 1011
Fayetteville, NC 28303-6040

Phone

(443) 762-1987

Fax

(910) 779-1099

NPI assigned

Oct 13, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kingsley Momodu, DDS & Associates, PLLC

  • Dental Clinic/Center
  • Fayetteville, NC
  • NPI 1801148457
  NPD Authorized official
• Rafael Rivera, Jr., DDS, PLLC

  • Dentist
  • Fayetteville, NC
  • NPI 1285803197
  NPD (past)

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1285919902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 BREEZEWOOD AVE STE 1011",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283036040",
            "telephone_number": "443-762-1987",
            "fax_number": "910-779-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 BREEZEWOOD AVE STE 1011",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283036040",
            "telephone_number": "443-762-1987",
            "fax_number": "910-779-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOMODU",
        "first_name": "KINGSLEY",
        "middle_name": "OISE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-13",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "9234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Alexis Molnar
• Kimberly E Molnar, MED
• Megan Molter
• Mommas Village Fayetteville Inc
• Ifeanyi Ifeoma Momodu, M.D.
• Madeline Everitt Monday
• Elizabeth Ann Monge, LCMHC, LPA
• Adrienne Lynette Monroe, MSW, LCSW
• Bianca Faith Monroe, MSW, LCAS-A, LCSW-A
• Charlotte Suzette Monroe

• Dentist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; 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.