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General NPI Number Information
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NPI Number | 1972287480
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Entity Type | Individual
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Provider Name | ALIYAH IMANI WILSON DDS
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 28 MADISON ST
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City | OAK PARK
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State | IL
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Zip | 60302-4230
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Country | US
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Telephone | 708-848-0528
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Fax |
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Provider Business Mailing Address
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Address Line | 218 E GRAND AVE APT 1912
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City | CHICAGO
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State | IL
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Zip | 60611-3713
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Country | US
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Telephone | 314-315-3599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021003479
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License Number State | IL
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