Provider Demographics
NPI:1912262627
Name:ALAN E. CHILES, DMD, PC
Entity Type:Organization
Organization Name:ALAN E. CHILES, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-324-6223
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-0116
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019604261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental