Provider Demographics
NPI:1396976304
Name:ADELAKUN, ALABA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALABA
Middle Name:
Last Name:ADELAKUN
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 1:1658 W BELMONT AVE # CE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3069
Mailing Address - Country:US
Mailing Address - Phone:773-649-5200
Mailing Address - Fax:773-649-5201
Practice Address - Street 1:1658 W BELMONT AVE # CE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3069
Practice Address - Country:US
Practice Address - Phone:773-649-5200
Practice Address - Fax:773-649-5201
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-027984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-027984OtherSTATE LICENSE NUMBER