Provider Demographics
NPI:1861787525
Name:ALALEH DOWLATSHAHI DDS,MS,PC.
Entity type:Organization
Organization Name:ALALEH DOWLATSHAHI DDS,MS,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLATSHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-388-0109
Mailing Address - Street 1:1525 S SANGAMON STREET
Mailing Address - Street 2:SUITE 617
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:312-388-0109
Mailing Address - Fax:
Practice Address - Street 1:1525 S SANGAMON ST
Practice Address - Street 2:SUITE 617
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1069
Practice Address - Country:US
Practice Address - Phone:312-388-0109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19027868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty