MEDICARE: DR. ANDREW OLUSEGUN ABOLARIN DDS

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	1223G0001X	General Practice Dentistry	052102	NY
2	122300000X	Dentist	DS037319	PA
3	1223G0001X	General Practice Dentistry	DI02310800	NJ

General Provider Information

NPI Number	:	1700973567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW OLUSEGUN ABOLARIN DDS

Provider Business Mailing Address
First Line	:	7439 FRANKFORD AVE
Second Line	:	FL 2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3600
Country	:	US
Telephone Number	:	215-613-5808
Fax Number	:	215-613-5818

Provider Business Practice Location Address
First Line	:	7439 FRANKFORD AVE
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3600
Country	:	US
Telephone Number	:	215-613-5808
Fax Number	:	215-613-6818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	02/22/2016

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