Individual
ALEX GARO TANIELIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
111 W JACKSON BLVD STE 1410, CHICAGO, IL 60604-3867
(312) 939-2400
Mailing address
111 W JACKSON BLVD STE 1410, CHICAGO, IL 60604-3867
(312) 939-2400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
61272179
WA
1223G0001X
General Practice Dentistry
Primary
019032206
IL
1223G0001X
General Practice Dentistry
63714
CA
Other
Enumeration date
07/29/2014
Last updated
07/06/2022
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