Provider Demographics
NPI:1730870106
Name:MENE-AFEJUKU, BAMIDELE (DMD)
Entity type:Individual
Prefix:
First Name:BAMIDELE
Middle Name:
Last Name:MENE-AFEJUKU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1535
Mailing Address - Country:US
Mailing Address - Phone:917-463-9829
Mailing Address - Fax:
Practice Address - Street 1:564 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1535
Practice Address - Country:US
Practice Address - Phone:917-463-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI02972400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program