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General NPI Number Information
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NPI Number | 1700973567
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Entity Type | Individual
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Provider Name | ANDREW OLUSEGUN ABOLARIN DDS
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 7439 FRANKFORD AVE 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3600
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Country | US
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Telephone | 215-613-5808
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Fax | 215-613-6818
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Provider Business Mailing Address
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Address Line | 7439 FRANKFORD AVE FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3600
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Country | US
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Telephone | 215-613-5808
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Fax | 215-613-5818
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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 | 052102
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS037319
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI02310800
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License Number State | NJ
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