Alia Ezziddin D.M.D., P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027203 Issued in IL

Legal business name

ALIA EZZIDDIN D.M.D., P.C.

Practice address

711 11TH St
Wilmette, IL 60091-2671

Phone

(847) 906-8676

NPI assigned

Feb 13, 2009

Last updated

Jun 24, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alia Ezziddin, DMD

Title

Dentist/Owner/President

Phone

(847) 906-8676

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1649419623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 11TH ST",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912671",
            "telephone_number": "847-906-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 11TH ST",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912671",
            "telephone_number": "847-906-8676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALIA EZZIDDIN D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-13",
        "last_updated": "2016-06-24",
        "status": "A",
        "authorized_official_last_name": "EZZIDDIN",
        "authorized_official_first_name": "ALIA",
        "authorized_official_title_or_position": "DENTIST/OWNER/PRESIDENT",
        "authorized_official_telephone_number": "847-906-8676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian James Ahlstrom, MAT, LAT, ATC
• Seonghan Ahn
• Sheila Ahranjani, PHARM.D.
• John Trinidad Alano
• Lisa Braband Albrighton, P.T.
• Rhodora Luzod Allado, PHARMACIST
• Javier Steven Alonso, LPC, CADC
• Ellen Sachs Alter, PHD
• Alternative Rehabilitation & Therapeutic Services, LLC (Healing A.R.T.S.)
• Roberto Amato, M.A., L.C.P.C

• General Practice Dentistry in Wilmette, IL
• Providers in Wilmette, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.