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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