Loni Nicol Adebayo, D.D.S.
Individual provider Active NPI Dentist · Chicago, IL
NPI 1366736720 · NPPES record last updated May 31, 2013
Key facts
- NPI
- 1366736720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.028397 (IL)
- Practice address
- 5637 W Fullerton Ave
Chicago, IL 60639-2351 - Phone
- (708) 951-0637
- NPI assigned
- Jun 2, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028397 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.028397 | IL | Yes |
Addresses
Primary practice location
5637 W Fullerton Ave
Chicago, IL 60639-2351
Mailing address
5637 W Fullerton Ave
Chicago, IL 60639-2351
Phone (708) 951-0637
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.