Provider Demographics
NPI:1467547133
Name:FRANKLIN, ALICIA DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:DIANE
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8328 SOUTH ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-4606
Mailing Address - Country:US
Mailing Address - Phone:773-445-3405
Mailing Address - Fax:773-445-3402
Practice Address - Street 1:8328 SOUTH ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4606
Practice Address - Country:US
Practice Address - Phone:773-445-3405
Practice Address - Fax:773-445-3405
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1005238Medicaid