NPI 1962029934 · live from the CMS NPI Registry
Abisola Jegede, DMD, MPH
Dentist, Orthodontics and Dentofacial Orthopedics in South Bend, IN. National Provider Identifier 1962029934, active.
NPI record
| NPI | 1962029934 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 919 E Jefferson Blvd Ste 100, South Bend, IN 46617 |
| Practice phone | 574-245-7504 |
| Mailing address | 3411 Nelson Rd Ste 100, Lake Charles, LA 70605 |
| Enumerated | June 25, 2020 |
| Last updated | August 20, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | 7109 (LA) |
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 12014860A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.