Provider Demographics
NPI:1770770646
Name:AVERY, CHESKA DEKELIA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHESKA
Middle Name:DEKELIA
Last Name:AVERY
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 1:1709 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-5133
Mailing Address - Country:US
Mailing Address - Phone:847-662-6080
Mailing Address - Fax:847-662-6086
Practice Address - Street 1:1709 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-5133
Practice Address - Country:US
Practice Address - Phone:847-662-6080
Practice Address - Fax:847-662-6086
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027183122300000X
WI6199-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist