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General NPI Number Information
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NPI Number | 1558632604
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Entity Type | Organization
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Legal Business Name | ESS DENTAL
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Dates
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Enumeration Date | 01/21/2012
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Last Update Date | 01/21/2012
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Provider Practice Location Address
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Address Line | 10554 S EWING AVE #2
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City | CHICAGO
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State | IL
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Zip | 60617-6219
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Country | US
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Telephone | 773-221-8200
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Fax | 773-375-4995
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Provider Business Mailing Address
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Address Line | 10554 S EWING AVE #2
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City | CHICAGO
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State | IL
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Zip | 60617-6219
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Country | US
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Telephone | 773-221-8200
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Fax | 773-375-4995
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FUNMI ADELEKE
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Credential | DDS
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Telephone | 773-221-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019025347
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License Number State | IL
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