Healthcare Provider Details

I. General information

NPI: 1255184529
Provider Name (Legal Business Name): OLOMI DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 N CENTRAL AVE
CHICAGO IL
60634-1815
US

IV. Provider business mailing address

4307 N CENTRAL AVE
CHICAGO IL
60634-1815
US

V. Phone/Fax

Practice location:
  • Phone: 773-286-0300
  • Fax:
Mailing address:
  • Phone: 773-286-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMIL OLOMI
Title or Position: OWNER
Credential: DMD
Phone: 224-565-7705