Ekinomo Odufalu Dental Inc

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

45799 Issued in CA

Legal business name

EKINOMO ODUFALU DENTAL INC

Doing business as

tri-city family dental

Practice address

1402 Industrial Park Ave
Redlands, CA 92374-4517

Phone

(909) 798-5777

NPI assigned

Feb 14, 2017

Last updated

Feb 14, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ekinomo OdufaluNPI 1881916047

Title

President

Phone

(951) 515-2985

Specialties & licenses 1

Addresses

Other names 1

• tri-city family dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ekinomo A Odufalu, DDS

  • General Practice Dentistry
  • Redlands, CA
  • NPI 1881916047
  NPD (past) Authorized official

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

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1952840605",
    "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": {
        "organization_name": "EKINOMO ODUFALU DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-14",
        "last_updated": "2017-02-14",
        "status": "A",
        "authorized_official_last_name": "ODUFALU",
        "authorized_official_first_name": "EKINOMO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-515-2985"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "45799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "tri-city family dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Eguia, M.D.
• Jennifer Anne Ehteshami, PA-C
• Eittol, Inc. (Christopher Ranch)
• Eittol, Inc. (Christopher Highland Ranch)
• Eittol, Inc. (Christopher Ranch II)
• Joyce Olufunmilola Ekong, CNS
• Ufan James Ekpo
• Raed El Hajjaoui, M.D.
• Mohamed El-Laham, DDS
• Rabeah Elbanna, RPH

• Preferred Provider Organization in Redlands, CA
• Providers in Redlands, CA by specialty
• Preferred Provider Organization 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.