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General NPI Number Information
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NPI Number | 1679281455
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Entity Type | Organization
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Legal Business Name | DR. OSUJI DENTAL, PLLC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 636 CHURCH ST STE 200W
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City | EVANSTON
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State | IL
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Zip | 60201-4578
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Country | US
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Telephone | 847-448-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 644 W 16TH ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60616-1179
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Country | US
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Telephone | 708-559-7259
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DR. AMINAT YEWANDE OSUJI
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Credential | DDS
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Telephone | 708-559-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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