Active NPI
Abisola Jegede, DMD, MPH
- Orthodontics and Dentofacial Orthopedics Dentistry
- South Bend, IN
National Provider Identifier
1962029934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 12014860A
- Practice address
- 919 E Jefferson Blvd Ste 100
South Bend, IN 46617-3112 - Phone
- (574) 245-7504
- NPI assigned
- Jun 25, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7109 | LA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12014860A | IN | Primary |
Addresses
Primary practice location
919 E Jefferson Blvd Ste 100
South Bend, IN 46617-3112
Mailing address
3411 Nelson Rd Ste 100
Lake Charles, LA 70605-1240
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 |
|---|---|---|---|
| 12014860A | IN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755648000000",
"number": "1962029934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3411 NELSON RD STE 100",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706051240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 E JEFFERSON BLVD STE 100",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173112",
"telephone_number": "574-245-7504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEGEDE",
"first_name": "ABISOLA",
"name_prefix": "Dr.",
"credential": "DMD, MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-25",
"last_updated": "2025-08-20",
"certification_date": "2025-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "7109",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IN",
"license": "12014860A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.