Individual provider Active NPI

Moyosola Afolabi, DMD

  • Dentist
  • Plano, TX
National Provider Identifier
1689308835
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
40410 Issued in TX
Practice address
7120 Coit Rd Ste 110
Plano, TX 75025-2097
Phone
(972) 208-0333
NPI assigned
Jul 13, 2022
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN1859575 MA
Dentist 122300000X 40410 TX Primary

Addresses

Primary practice location

7120 Coit Rd Ste 110
Plano, TX 75025-2097

Mailing address

7120 Coit Rd Ste 110
Plano, TX 75025-2097
Phone (972) 208-0333

Other practice location 1

45 Dimock St
Roxbury, MA 02119-1208
Phone (617) 442-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20221101000358 MA Practitioner - Dentist 6204203490

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40410TXMDGroup Psychotherapy Psychologist
DN1859575MAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Plano Modern Dentistry, PC PastSince Jul 21, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1689308835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7120 COIT RD STE 110",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750252097",
            "telephone_number": "972-208-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7120 COIT RD STE 110",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750252097",
            "telephone_number": "972-208-0333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 Dimock St",
            "address_purpose": "LOCATION",
            "city": "Roxbury",
            "state": "MA",
            "postal_code": "021191208",
            "country_code": "US",
            "telephone_number": "617-442-8800",
            "fax_number": "617-547-0950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AFOLABI",
        "first_name": "MOYOSOLA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1859575",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "40410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.