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General NPI Number Information
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NPI Number | 1124373899
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Entity Type | Individual
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Provider Name | ADEWALE OLAILAN LAWAL DMD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 10/23/2016
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Provider Practice Location Address
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Address Line | 4259 S BERKELEY AVE
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City | CHICAGO
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State | IL
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Zip | 60653-3030
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Country | US
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Telephone | 312-646-6620
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Fax | 773-624-5642
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Provider Business Mailing Address
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Address Line | 7250 S DORCHESTER AVE
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City | CHICAGO
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State | IL
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Zip | 60619-1543
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Country | US
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Telephone | 312-550-1886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019029027
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License Number State | IL
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