Provider Demographics
NPI:1376863373
Name:HAMMOND DENTAL GROUP
Entity Type:Organization
Organization Name:HAMMOND DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLADIMEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-678-5895
Mailing Address - Street 1:3302 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3421
Mailing Address - Country:US
Mailing Address - Phone:773-542-1916
Mailing Address - Fax:773-542-1910
Practice Address - Street 1:3302 GROVE AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3421
Practice Address - Country:US
Practice Address - Phone:773-542-1916
Practice Address - Fax:773-542-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12011374A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty