Provider Demographics
NPI:1912078734
Name:AVER, ALLA (DDS)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:AVER
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 1:2400 RAVINE WAY #400
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-998-5100
Mailing Address - Fax:847-998-5252
Practice Address - Street 1:2400 RAVINE WAY #400
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-998-5100
Practice Address - Fax:847-998-5252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist