Provider Demographics
NPI:1558632604
Name:ESS DENTAL
Entity Type:Organization
Organization Name:ESS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-221-8200
Mailing Address - Street 1:10554 S EWING AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6219
Mailing Address - Country:US
Mailing Address - Phone:773-221-8200
Mailing Address - Fax:773-375-4995
Practice Address - Street 1:10554 S EWING AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6219
Practice Address - Country:US
Practice Address - Phone:773-221-8200
Practice Address - Fax:773-375-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty