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Organization
DR SAM DMD PC
Active
Organization
DR SAM DMD PC
Active
Other names
162nd Street Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL OSOBU (PRESIDENT)
(312) 493-6089
Entity
Organization
Contact information
Practice address
1022 E 162ND ST, SOUTH HOLLAND, IL 60473-2560
(312) 493-6089
Mailing address
2120 W WASHINGTON BLVD, SUITE. 306, CHICAGO, IL 60612-2346
(312) 493-6089
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019030498
IL
Other
Enumeration date
04/06/2017
Last updated
04/06/2017
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