Provider Demographics
NPI:1093143794
Name:ADEKOLA, ADEMOLA JIMOH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADEMOLA
Middle Name:JIMOH
Last Name:ADEKOLA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2811
Mailing Address - Country:US
Mailing Address - Phone:312-994-4460
Mailing Address - Fax:
Practice Address - Street 1:955 W MONROE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2811
Practice Address - Country:US
Practice Address - Phone:312-994-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190295531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice