Provider Demographics
NPI:1972287480
Name:WILSON, ALIYAH IMANI (DDS)
Entity type:Individual
Prefix:
First Name:ALIYAH
Middle Name:IMANI
Last Name:WILSON
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 1:218 E GRAND AVE APT 1912
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3713
Mailing Address - Country:US
Mailing Address - Phone:314-315-3599
Mailing Address - Fax:
Practice Address - Street 1:28 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4230
Practice Address - Country:US
Practice Address - Phone:708-848-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210034791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry