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NPI Code Detail

MEDICARE: ADEWALE OLAILAN LAWAL DMD

MEDICARE: ADEWALE OLAILAN LAWAL DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019029027IL

General Provider Information

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

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Directions to “ ADEWALE OLAILAN LAWAL DMD” Practice Location

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