Provider Demographics
NPI:1700973567
Name:ABOLARIN, ANDREW OLUSEGUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:OLUSEGUN
Last Name:ABOLARIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7439 FRANKFORD AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3600
Mailing Address - Country:US
Mailing Address - Phone:215-613-5808
Mailing Address - Fax:215-613-5818
Practice Address - Street 1:7439 FRANKFORD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3600
Practice Address - Country:US
Practice Address - Phone:215-613-5808
Practice Address - Fax:215-613-6818
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521021223G0001X
PADS037319122300000X
NJDI023108001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice