Ebosetale Odiaogbe Okoruwa, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14478 Issued in MN

Practice address

6936 Pine Arbor Dr S Ste 230
Cottage Grove, MN 55016-4645

Phone

(651) 204-5257

NPI assigned

Apr 16, 2018

Last updated

Feb 12, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Abba Healthcare PLLC

  dba Cottage Grove Pediatric Dentistry

  • Dental Clinic/Center
  • Cottage Grove, MN
  • NPI 1023872835
  NPD Authorized official
• Twin Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Blaine, MN
  • NPI 1558184739
  NPD

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1417444332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2052 IRENE ST",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136613",
            "telephone_number": "712-309-6588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6936 PINE ARBOR DR S STE 230",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164645",
            "telephone_number": "651-204-5257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKORUWA",
        "first_name": "EBOSETALE",
        "middle_name": "ODIAOGBE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1002470",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14478",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adefunke Rachel Odujole
• Oyeyemi Elizabeth Odujole
• Oehler Chiropractic P.L.L.C.
• Dustin Lee Oehler, D.C.
• Kenneth Nworah Okafor, PHARMD
• Robyn C Oliver, MD
• Lindsey Patricia Olsen
• David A. Olson, MD
• Jennifer Olszewski
• Mutiat Ayobamidele Olukoga, FNP

• Dentist in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.