Olusegun K. Alonge, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20289 Issued in TX

Practice address

624 Mary Lake Dr
Bryan, TX 77801-3423

Phone

(979) 846-2500

Fax

(979) 846-2530

NPI assigned

Nov 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 1996

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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.

• Harris County Hospital District

  • Family Medicine Physician
  • Houston, TX
  • NPI 1356428460

  General Practice

  NPD
• Brazos Valley Community Action Agency, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bryan, TX
  • NPI 1184192064
  NPD (past)
• Brazos Valley Community Action Agency, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bryan, TX
  • NPI 1649265646
  NPD (past)
• Brazos Valley Community Action Agency, Inc.

  • Obstetrics Physician
  • College Station, TX
  • NPI 1811171580
  NPD (past)

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308528000000",
    "number": "1548243249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 UNIVERSITY DR E",
            "address_2": "#100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778402600",
            "telephone_number": "979-846-1100",
            "fax_number": "979-260-9390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MARY LAKE DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778013423",
            "telephone_number": "979-846-2500",
            "fax_number": "979-846-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALONGE",
        "first_name": "OLUSEGUN",
        "middle_name": "K.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2011-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "20289",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI CINIC B",
            "identifier": "1649265646",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154467801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI AGENCY",
            "identifier": "1821185299",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154467803",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI CLINIC R",
            "identifier": "1275620551",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "741715140",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Jean Allen, OTR
• Jasmine Alli, MS
• Alliance Health Providers of the Brazos Valley
• Joseph Scott Allison, OD
• Melanie Almaguer
• Heather Alphord
• Karla Marie Alvarez, LCSW
• Maria O. Alvarez, LMT
• Adriana Nicolle Amagliani, PHARM.D.
• Amanda Pasley Gray, LPC, PLLC

• General Practice Dentistry in Bryan, TX
• Providers in Bryan, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.