Individual
ERID ALIAJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 N CLARK ST, DENTAL DREAMS LLC DANIELLE THARP 6TH FLOOR, CHICAGO, IL 60654-4712
(708) 699-3080
Mailing address
350 N CLARK ST, DENTAL DREAMS LLC DANIELLE THARP 6TH FLOOR, CHICAGO, IL 60654-4712
(708) 699-3080
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030100
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/25/2014
Last updated
05/29/2015
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