Provider Demographics
NPI:1376995688
Name:FUNWAL LLC
Entity Type:Organization
Organization Name:FUNWAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BABATUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-827-8484
Mailing Address - Street 1:1695 ELK BLVD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4721
Mailing Address - Country:US
Mailing Address - Phone:847-727-8484
Mailing Address - Fax:224-361-3611
Practice Address - Street 1:1695 ELK BLVD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4721
Practice Address - Country:US
Practice Address - Phone:847-727-8484
Practice Address - Fax:224-361-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190253471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty