Provider Demographics
NPI:1952735755
Name:ALLA SHTILMAN DDS
Entity Type:Organization
Organization Name:ALLA SHTILMAN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-409-0091
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190294341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty