Healthcare Provider Details

I. General information

NPI: 1609541655
Provider Name (Legal Business Name): AKINWALE AKINWANDE DDS MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21128 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

IV. Provider business mailing address

21128 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-6465
  • Fax: 815-464-6479
Mailing address:
  • Phone: 815-464-6465
  • Fax: 815-464-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AKINWALE BANJI AKINWANDE
Title or Position: PRESIDENT/ OWNER
Credential: DDS, MS
Phone: 815-464-6465