Provider Demographics
NPI:1689394041
Name:OSINUSI, ADENIKE (DDS)
Entity type:Individual
Prefix:DR
First Name:ADENIKE
Middle Name:
Last Name:OSINUSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 GEORGE BUSBEE PKWY NW APT 5304
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4861
Mailing Address - Country:US
Mailing Address - Phone:205-201-8886
Mailing Address - Fax:
Practice Address - Street 1:3752 CASCADE RD SW STE 190
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2149
Practice Address - Country:US
Practice Address - Phone:678-836-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02927700122300000X
GADN1233231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist