Active NPI
Deborah Oluwakemi Bodunde
- Periodontics
- Columbus, OH
National Provider Identifier
1619604469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- RES.004499
- Practice address
- 305 W 12TH Ave
Columbus, OH 43210 - Phone
- (614) 688-3763
- NPI assigned
- Aug 2, 2022
- Reactivated
- Apr 3, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | RES.004499 | OH | Primary |
Addresses
Primary practice location
305 W 12TH Ave
Columbus, OH 43210
Mailing address
1596 Highland Street
Apt E
Columbus, OH 43201
Phone (614) 589-2203
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 |
|---|---|---|---|
| RES.004499 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680480000000",
"number": "1619604469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1596 HIGHLAND STREET",
"address_2": "APT E",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43201",
"telephone_number": "614-589-2203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W 12TH AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43210",
"telephone_number": "614-688-3763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODUNDE",
"first_name": "DEBORAH",
"middle_name": "OLUWAKEMI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-02",
"last_updated": "2023-04-03",
"certification_date": "2023-04-03",
"deactivation_date": "2023-03-13",
"reactivation_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "RES.004499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.