Provider Demographics
NPI:1720028855
Name:CHILES, ALAN E (DMD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:CHILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1911
Mailing Address - Country:US
Mailing Address - Phone:217-324-6223
Mailing Address - Fax:217-324-9101
Practice Address - Street 1:318 N MADISON ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1911
Practice Address - Country:US
Practice Address - Phone:217-324-6223
Practice Address - Fax:217-324-9101
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0196041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice