Provider Demographics
NPI:1649631052
Name:ALABA A. ADELAKUN, D.D.S., P.C.
Entity type:Organization
Organization Name:ALABA A. ADELAKUN, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALABA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADELAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-649-5200
Mailing Address - Street 1:1658 W BELMONT AVE
Mailing Address - Street 2:SUITE CE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3069
Mailing Address - Country:US
Mailing Address - Phone:773-649-5200
Mailing Address - Fax:773-649-5201
Practice Address - Street 1:1658 W BELMONT AVE
Practice Address - Street 2:SUITE CE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3069
Practice Address - Country:US
Practice Address - Phone:773-649-5200
Practice Address - Fax:773-649-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027984261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental