Provider Demographics
NPI:1831649284
Name:OLAITAN OKEDIJI DDS, PC
Entity Type:Organization
Organization Name:OLAITAN OKEDIJI DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAITAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKEDIJI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-280-0034
Mailing Address - Street 1:233 E ERIE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-280-0034
Mailing Address - Fax:312-280-7768
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-280-0034
Practice Address - Fax:312-280-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental