Active NPI
Bisi Joseph Ekundayo, DMD
- Dentist
- Shreveport, LA
National Provider Identifier
1558918722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001317-15
- Practice address
- 1625 David Raines Rd
Shreveport, LA 71107-5899 - Phone
- (318) 425-2252
- Fax
- (318) 425-2367
- NPI assigned
- Aug 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7024 | LA | |
| Dentist | 122300000X | 38070 | TX | |
| Dentist | 122300000X | 6001317-15 | WI | Primary |
Addresses
Primary practice location
1625 David Raines Rd
Shreveport, LA 71107-5899
Mailing address
3041 Dr Martin Luther King Dr
Shreveport, LA 71107-4705
Phone (318) 227-3350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38070 | TX | MD | Dentist |
| 6001317-15 | WI | MD | Dentist |
| 7024 | LA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1558918722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3041 DR MARTIN LUTHER KING DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711074705",
"telephone_number": "318-227-3350",
"fax_number": "318-222-2979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 DAVID RAINES RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711075899",
"telephone_number": "318-425-2252",
"fax_number": "318-425-2367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EKUNDAYO",
"first_name": "BISI",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-22",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "7024",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "38070",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001317-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.