Individual
DR. ALIA EZZIDDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
924 HARVARD LN, WILMETTE, IL 60091-1421
(312) 237-6390
Mailing address
924 HARVARD LN, WILMETTE, IL 60091-1421
(312) 237-6390
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.027203
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9185375
—
IL
Enumeration date
01/25/2007
Last updated
06/24/2016
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