MEDICARE: DR. OSUJI DENTAL, PLLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679281455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. OSUJI DENTAL, PLLC

Provider Business Mailing Address
First Line	:	644 W 16TH ST UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1179
Country	:	US
Telephone Number	:	708-559-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 CHURCH ST STE 200W
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4578
Country	:	US
Telephone Number	:	847-448-1684
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/ OWNER
Name	:	DR. AMINAT YEWANDE OSUJI
Credential	:	DDS
Telephone Number	:	708-559-7259

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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