Provider Demographics
NPI:1265437388
Name:AWOFALA, KEHINDE (DDS)
Entity type:Individual
Prefix:DR
First Name:KEHINDE
Middle Name:
Last Name:AWOFALA
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 1:28303 DEQUINDRE RD
Mailing Address - Street 2:STE 130
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3040
Mailing Address - Country:US
Mailing Address - Phone:248-545-7288
Mailing Address - Fax:248-545-7279
Practice Address - Street 1:28303 DEQUINDRE RD
Practice Address - Street 2:STE 130
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3040
Practice Address - Country:US
Practice Address - Phone:248-545-7288
Practice Address - Fax:248-545-7279
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice