Provider Demographics
NPI:1609541655
Name:AKINWALE AKINWANDE DDS MS PLLC
Entity type:Organization
Organization Name:AKINWALE AKINWANDE DDS MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINWALE
Authorized Official - Middle Name:BANJI
Authorized Official - Last Name:AKINWANDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:815-464-6465
Mailing Address - Street 1:21128 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3112
Mailing Address - Country:US
Mailing Address - Phone:815-464-6465
Mailing Address - Fax:815-464-6479
Practice Address - Street 1:21128 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3112
Practice Address - Country:US
Practice Address - Phone:815-464-6465
Practice Address - Fax:815-464-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty