David Olatunji Omole, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

62170 Issued in KS

Practice address

2301 N Waldron St.
Hutchinson, KS 67502

Phone

(620) 663-1141

Fax

(620) 663-1373

NPI assigned

Apr 24, 2019

Reactivated

Jan 28, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Univ of Western Ontario Schulich School of Med, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Southwind Oral and Facial Surgery LLCGroup PAC ID 7517378524, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hutchinson Regional Medical Center Inc Hospital, Hutchinson, KS, CCN 170020

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Southwind Oral and Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Hutchinson, KS
  • NPI 1093818478
  Medicare reassignment Care Compare group NPD
• W.R. Whitlow, D.D.S., PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Wichita, KS
  • NPI 1265530927
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hutchinson Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Hutchinson, KS
  • NPI 1922039320
  Care Compare affiliation

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1528622735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 N WALDRON ST.",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "67502",
            "telephone_number": "620-663-1141",
            "fax_number": "620-663-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N WALDRON ST.",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "67502",
            "telephone_number": "620-663-1141",
            "fax_number": "620-663-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOLE",
        "first_name": "DAVID",
        "middle_name": "OLATUNJI",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-24",
        "last_updated": "2024-08-09",
        "certification_date": "2020-01-28",
        "deactivation_date": "2019-12-09",
        "reactivation_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ZZ",
            "license": "117025",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KS",
            "license": "62170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenilee Joy O'Neal, PT
• Alissa Danae O'Neill, FNP-C
• Oasis Home Care of KS LLC
• Alissa Lynn Ogburn, R.D
• Caitlin Amber Olson, MD
• Celeste Y. Ontjes, R.PH.
• Zoe Oppriecht
• Leslie K Osborn, DC
• Abigail D Osborne
• Matthew J Osenbaugh, PA

• Oral and Maxillofacial Surgery (Dentist) in Hutchinson, KS
• Providers in Hutchinson, KS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.