Provider Demographics
NPI:1609994433
Name:ATTAR, ALA DEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALA DEAN
Middle Name:
Last Name:ATTAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:712 FLORSHEIM DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5270
Mailing Address - Country:US
Mailing Address - Phone:847-573-1904
Mailing Address - Fax:847-573-1535
Practice Address - Street 1:712 FLORSHEIM DR STE 12
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5270
Practice Address - Country:US
Practice Address - Phone:847-573-1904
Practice Address - Fax:847-573-1535
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0251511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice