Healthcare Provider Details

I. General information

NPI: 1720830193
Provider Name (Legal Business Name): ALLISON BEBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 S WESTERN AVE # 4
CHICAGO IL
60643-3100
US

IV. Provider business mailing address

12845 W LAUFFER RD
MOKENA IL
60448-9010
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-3200
  • Fax:
Mailing address:
  • Phone: 815-641-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.036033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: