Alia Ezziddin, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.027203 Issued in IL

Practice address

924 Harvard LN
Wilmette, IL 60091-1421

Phone

(312) 237-6390

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1780739912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 HARVARD LN",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911421",
            "telephone_number": "312-237-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 HARVARD LN",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911421",
            "telephone_number": "312-237-6390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZZIDDIN",
        "first_name": "ALIA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.027203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9185375",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jimena Ines Escurra, LCPC
• Samantha Marie Espinoza, DNP PNP-PC
• Nina Esshaki, LPC
• Morgan Etheridge
• Kristoffer Evangelista, BA PSYCHOLOGY
• Faith Mitchel Fairclough, RN BSN IBCLC
• Charles Michael Falcone
• Mitra Farahati, MD
• Carol Feiss, PSYD
• Adrienne M Felder, 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.