DR. MODUPE MARY OGUNNUSI SOFUYE (NPI# 1437644549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437644549 |
| Entity Type | Individual |
| Full Name | DR. MODUPE MARY OGUNNUSI SOFUYE |
| Credential | DMD |
| Practice Address |
1290 E Ireland Rd South Bend IN 46614-3474 |
| Mailing Address |
823b Sorin St South Bend IN 46617-2047 |
| Practice Telephone | 5742991400 |
| Mailing Telephone | 7866194170 |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2018-06-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
12012973A | IN | Dental Providers |
| Street Address |
1290 E IRELAND RD |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46614-3474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417574013 | Hellen Gathesha | Nurse Practitioner | 2123 W Irvington Dr, South Bend, IN 46614 | 2020-06-30 |
| 1033759394 | Diane Galvas | Pharmacist | 1217 E. Ireland Rd., South Bend, IN 46614 | 2020-01-14 |
| 1730668690 | Julenne Henriquez-gil | Physical Therapist | 202 W Ireland Rd Ste 101a, South Bend, IN 46614 | 2018-08-11 |
| 1467747014 | Deidre A Coffey | Nurse Practitioner | 1025 Widener Ln, South Bend, IN 46614 | 2011-06-12 |
| 1588727655 | Wal-mart Stores East, Lp | Technician/Technologist | 700 W. Ireland Rd., South Bend, IN 46614 | 2006-12-19 |
| 1437262847 | Lori F Risser | Dentist | 734 E Ireland Rd, South Bend, IN 46614 | 2006-08-17 |
| 1912388018 | Laura Ellen Albright | Family Medicine | 2102 E Inwood Rd, South Bend, IN 46614 | 2015-06-15 |
| 1245626225 | Kathleen Kelley | Dermatology | 1815 E Ireland Rd, South Bend, IN 46614 | 2015-04-07 |
| 1073869806 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 1950 Ridgedale Rd, South Bend, IN 46614 | 2012-07-30 |
| 1326300666 | Kristine Marie Jones | Optometrist | 700 W Ireland Rd, South Bend, IN 46614 | 2012-06-12 |
| Find all providers in zip 46614 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871116673 | Chelsea Ann Myers | Dentist | 206 W Ireland Rd, South Bend, IN 46614-2506 | 2020-05-27 |
| 1508020066 | Gerald Warrell | Dentist | 2314 Miami St, South Bend, IN 46614-1336 | 2008-07-14 |
| 1619144672 | James Alvin Douglas | Dentist | 820 E Colfax Ave, South Bend, IN 46617-2804 | 2008-05-09 |
| 1962670208 | Paul Michael Mcleod | Dentist | 919 E Jefferson Blvd Ste Ll02, South Bend, IN 46617-3119 | 2008-02-20 |
| 1447428248 | Daniel Frederick Lindborg | Dentist | 52303 Emmons Road, Suite 17, South Bend, IN 46637-4294 | 2008-02-14 |
| 1275701369 | Geoffrey A. Klopenstine Dds PC | Dentist | 51584 Us Highway 33, South Bend, IN 46637-1704 | 2008-02-12 |
| 1659581007 | Philip Paul Hulecki | Dentist | 3608 Pleasant St, South Bend, IN 46615-2033 | 2007-05-23 |
| 1891917282 | Lifetime Dental Careof Indiana, PC | Dentist | 1605 North Ironwood, South Bend, IN 46635 | 2007-05-03 |
| 1780704247 | Douglas John Kosek | Dentist | 413 W Jefferson Blvd, South Bend, IN 46601-1514 | 2007-03-29 |
| 1578695086 | Charles Wesley Magnuson | Dentist | 1331 Chimes Blvd, South Bend, IN 46615-3549 | 2007-03-10 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46614 |
Please comment or provide details below to improve the information on DR. MODUPE MARY OGUNNUSI SOFUYE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.