Olawale Osinusi, DDS
Individual provider Active NPI Dentist · Sevierville, TN
NPI 1407345457 · NPPES record last updated Oct 28, 2020
Key facts
- NPI
- 1407345457
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 10662 (TN)
- Practice address
- 1436 Winfield Dunn Pkwy Ste 2
Sevierville, TN 37876-1582 - Phone
- (865) 657-7645
- NPI assigned
- May 4, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180820001843 | TN | Order and Referring Only - Dentist |
1557610821 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10662 | TN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| O2 Dental PLLC Dba Rooted Dental Co. | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 10662 | TN | Yes |
Addresses
Primary practice location
1436 Winfield Dunn Pkwy Ste 2
Sevierville, TN 37876-1582
Mailing address
1436 Winfield Dunn Pkwy Ste 2
Sevierville, TN 37876-1582
Phone (865) 657-7645
Other providers in Sevierville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.