Provider Demographics
NPI:1255823084
Name:SENALAN, ADEM (DMD)
Entity type:Individual
Prefix:DR
First Name:ADEM
Middle Name:
Last Name:SENALAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LITTLE MELODY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1060
Mailing Address - Country:US
Mailing Address - Phone:847-749-6875
Mailing Address - Fax:
Practice Address - Street 1:150 LITTLE MELODY LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1060
Practice Address - Country:US
Practice Address - Phone:847-749-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0316451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice