Moyosoreoluwa Adesoji Oyebolu, DMD
Individual provider Active NPI General Practice Dentistry · Christiansted, VI
NPI 1982257325 · NPPES record last updated Jun 19, 2024
Key facts
- NPI
- 1982257325
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2838 (VI)
- Practice address
- 4031 Estate la Grande Princesse Ste 33
Christiansted, VI 00820-5213 - Phone
- (340) 692-9770
- NPI assigned
- Jul 23, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019033538 | IL | MD | General Practice Dentistry |
| 2838 | VI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Experts, LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019033538 | IL | |
| General Practice Dentistry | 1223G0001X | 2838 | VI | Yes |
Addresses
Primary practice location
4031 Estate la Grande Princesse Ste 33
Christiansted, VI 00820-5213
Mailing address
3111 S Omar Ave
Tampa, FL 33629-7535
Phone (813) 504-2527
Other practice location 1
12200 Western Ave Ste 108
Blue Island, IL 60406-1493
Phone (708) 385-3700
Other providers in Christiansted, VI
- One Dental Practice LLC
- Ophthalmology Consultants, PC
- Orthocaribbean P.C.
- Orthocaribbean PC
- Gemaine Diane Owen
- Pain Medicine VI, PLLC
- Jong Hwa Park
- Sophia Joseph Parrilla
- Camille Marise Paul
- McKenna Peck
All providers in Christiansted, VI · General Practice Dentistry in U.S. Virgin Islands
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.