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General NPI Number Information
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NPI Number | 1114498052
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Entity Type | Organization
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Legal Business Name | GOLDEN RULE DENTAL LLC
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 4909 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60651-3161
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Country | US
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Telephone | 773-378-4608
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Fax |
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Provider Business Mailing Address
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Address Line | 900 S WESTERN AVE UNIT 5N
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City | CHICAGO
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State | IL
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Zip | 60612-4877
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Country | US
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Telephone | 312-834-3621
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FOLASHADE OGUNSANYA
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Credential | DDS
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Telephone | 312-834-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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