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NPI Code Detail

MEDICARE: DR. DE'AVLIN V OLGUIN D.D.S, M.S.

MEDICARE: DR. DE'AVLIN V OLGUIN D.D.S, M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodontics12010885IN
21223P0300XPeriodontics021002247IL
31223P0300XPeriodontics2901018231MI
4122300000XDentist019025660IL

General Provider Information

NPI Number : 1730271347
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DE'AVLIN V OLGUIN D.D.S, M.S.
Provider Business Mailing Address
First Line : 850 S WABASH AVE
Second Line : SUITE 240
City : CHICAGO
State : IL
Zip : 60605-3641
Country : US
Telephone Number : 312-356-4700
Fax Number : 312-356-4770
Provider Business Practice Location Address
First Line : 850 S WABASH AVE
Second Line : SUITE 240
City : CHICAGO
State : IL
Zip : 60605-3641
Country : US
Telephone Number : 312-356-4700
Fax Number : 312-356-4770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 01/25/2024

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