Healthcare Provider Details

I. General information

NPI: 1194285742
Provider Name (Legal Business Name): JAMIL OLOMI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 N CENTRAL AVE
CHICAGO IL
60634-1815
US

IV. Provider business mailing address

2630 N WASHTENAW AVE APT 2N
CHICAGO IL
60647-1824
US

V. Phone/Fax

Practice location:
  • Phone: 773-286-0300
  • Fax: 773-286-0340
Mailing address:
  • Phone: 224-565-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.032373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: