Provider Demographics
NPI:1871780171
Name:REGISTE, OLAITAN M (DDS)
Entity type:Individual
Prefix:
First Name:OLAITAN
Middle Name:M
Last Name:REGISTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:OLAITAN
Other - Middle Name:M
Other - Last Name:OKEDIJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:233 E ERIE ST #
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-280-0034
Mailing Address - Fax:312-280-7768
Practice Address - Street 1:233 E ERIE ST #
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-280-0034
Practice Address - Fax:312-280-7768
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190275171223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist