Provider Demographics
NPI:1932541943
Name:SHTILMAN, ALLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:SHTILMAN
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 1:1215 DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1121
Mailing Address - Country:US
Mailing Address - Phone:847-409-0091
Mailing Address - Fax:
Practice Address - Street 1:1464 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4433
Practice Address - Country:US
Practice Address - Phone:847-566-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190294341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice