Provider Demographics
NPI:1255184529
Name:OLOMI DENTAL, P.C.
Entity type:Organization
Organization Name:OLOMI DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:224-565-7705
Mailing Address - Street 1:4307 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1815
Mailing Address - Country:US
Mailing Address - Phone:773-286-0300
Mailing Address - Fax:
Practice Address - Street 1:4307 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1815
Practice Address - Country:US
Practice Address - Phone:773-286-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty