Provider Demographics
NPI:1194285742
Name:OLOMI, JAMIL (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIL
Middle Name:
Last Name:OLOMI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 N WASHTENAW AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1824
Mailing Address - Country:US
Mailing Address - Phone:224-565-7705
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:773-286-0340
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.0323731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program