Active NPI
Opeyemi Fadeyi, DDS
- General Practice Dentistry
- Mansfield, TX
National Provider Identifier
1669033189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 36000
- Practice address
- 2771 E Broad St Ste 221
Mansfield, TX 76063-9157 - Phone
- (817) 473-2277
- NPI assigned
- Jun 25, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 36000 | TX | Primary |
| Dentist | 122300000X | 1356 | OK |
Addresses
Primary practice location
2771 E Broad St Ste 221
Mansfield, TX 76063-9157
Mailing address
1807 Magic Valley LN
Cedar Hill, TX 75104-6947
Phone (817) 999-0587
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 |
|---|---|---|---|
| 36000 | TX | MD | Pharmacist |
| 1356 | OK | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orchard Dental and Orthodontics | General Practice | Past | Accepting new patients |
| Alterra Dental PLLC | Dentist | Past | Accepting new patients |
| PLW Anesthesia LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- General Practice Dentistry
- Mansfield, TX
- NPI 1962890525
-
- General Practice Dentistry
- Mansfield, TX
- NPI 1720341639
-
- Certified Registered Nurse Anesthetist
- Oklahoma City, OK
- NPI 1700040680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652227200000",
"number": "1669033189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 MAGIC VALLEY LN",
"city": "CEDAR HILL",
"state": "TX",
"postal_code": "751046947",
"telephone_number": "817-999-0587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2771 E BROAD ST STE 221",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760639157",
"telephone_number": "817-473-2277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADEYI",
"first_name": "OPEYEMI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-25",
"last_updated": "2022-05-11",
"certification_date": "2022-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "36000",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "1356",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.