Provider Demographics
NPI:1578185716
Name:OSUJI, AMINAT YEWANDE (DDS)
Entity Type:Individual
Prefix:
First Name:AMINAT
Middle Name:YEWANDE
Last Name:OSUJI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S CLAREMONT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-5126
Mailing Address - Country:US
Mailing Address - Phone:708-559-7259
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 200W
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4578
Practice Address - Country:US
Practice Address - Phone:847-448-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL43318951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty