Provider Demographics
NPI:1730271347
Name:OLGUIN, DE'AVLIN V (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DE'AVLIN
Middle Name:V
Last Name:OLGUIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S WABASH AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3641
Mailing Address - Country:US
Mailing Address - Phone:312-356-4700
Mailing Address - Fax:312-356-4770
Practice Address - Street 1:850 S WABASH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3641
Practice Address - Country:US
Practice Address - Phone:312-356-4700
Practice Address - Fax:312-356-4770
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120108851223P0300X
IL0210022471223P0300X
MI29010182311223P0300X
IL019025660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics