Provider Demographics
NPI:1225477169
Name:NILI, ALIREZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:NILI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WENNES CT
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2727
Mailing Address - Country:US
Mailing Address - Phone:630-531-1188
Mailing Address - Fax:
Practice Address - Street 1:2266 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7600
Practice Address - Country:US
Practice Address - Phone:773-528-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-029405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist