Provider Demographics
NPI:1366867442
Name:ALIAJ, ERID
Entity Type:Individual
Prefix:
First Name:ERID
Middle Name:
Last Name:ALIAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N CLARK ST
Mailing Address - Street 2:DENTAL DREAMS LLC DANIELLE THARP 6TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4712
Mailing Address - Country:US
Mailing Address - Phone:708-699-3080
Mailing Address - Fax:
Practice Address - Street 1:350 N CLARK ST
Practice Address - Street 2:DENTAL DREAMS LLC DANIELLE THARP 6TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4712
Practice Address - Country:US
Practice Address - Phone:708-699-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.030100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program