Ekinomo A Odufalu, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

45799 Issued in CA

Practice address

1402 Industrial Park Ave
Redlands, CA 92374-4517

Phone

(909) 798-5777

NPI assigned

Feb 15, 2010

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 CA

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

Practice roles

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.

• Ekinomo Odufalu Dental Inc

  • Preferred Provider Organization
  • Redlands, CA
  • NPI 1952840605
  NPD (past) Authorized official
• DRS.Jeevan & Neela Ghatnekar DDS. Inc.

  • General Practice Dentistry
  • Redlands, CA
  • NPI 1184806721
  NPD (past)

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

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1881916047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 INDUSTRIAL PARK AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923744517",
            "telephone_number": "909-798-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 INDUSTRIAL PARK AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923744517",
            "telephone_number": "909-798-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUFALU",
        "first_name": "EKINOMO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-15",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Ochoa
• Cherry Ann Gabuya Oculam, RN MS CFNP
• Betty Odak, LMFT
• Melissa Odonnell
• Kamran Odooli
• Justin Guiang Ogoy
• Karlee Dawn Ohm, MS, MFT
• Mac Rey Luna Ojano, DENTIST
• Anglae B Ojeda, FNP
• Camryn A Ojeda

• General Practice Dentistry in Redlands, CA
• Providers in Redlands, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.