Jesutofunmi Osundeko, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DE 60574855 Issued in WA

Practice address

8050 Freedom LN NE
Suite C
Lacey, WA 98516-4761

Phone

(360) 339-4373

NPI assigned

Sep 11, 2014

Last updated

Nov 16, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1410393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447632000000",
    "number": "1720489578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8050 FREEDOM LN NE",
            "address_2": "SUITE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164761",
            "telephone_number": "360-339-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8050 FREEDOM LN NE",
            "address_2": "SUITE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164761",
            "telephone_number": "360-339-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSUNDEKO",
        "first_name": "JESUTOFUNMI",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-11",
        "last_updated": "2015-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE 60574855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent Ortega
• Brooke Olivia Orth
• Ginaly M Osorio
• Molly Carolyn Ostrander, LMHC
• Jessa Louise Ostrom, DO
• F Michele Otto, RN
• George O Otura, LPC, LMHC
• Ahmad Oubaid, DMD
• Ovation Transportation Inc (Hearts of care)
• David Wayne Overton, PA-C

• Dentist in Lacey, WA
• Providers in Lacey, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.