Provider Demographics
NPI:1306134515
Name:OBI, ADITYA SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:ADITYA
Middle Name:SINGH
Last Name:OBI
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 1:6311 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2311
Mailing Address - Country:US
Mailing Address - Phone:718-737-4824
Mailing Address - Fax:630-395-9593
Practice Address - Street 1:6311 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2311
Practice Address - Country:US
Practice Address - Phone:718-737-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028785122300000X
ILIL019028785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist