Provider Demographics
NPI:1487740932
Name:FRANKLIN, CARLLA DUSTER (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLLA
Middle Name:DUSTER
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARLLA
Other - Middle Name:EVELYN
Other - Last Name:DUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:957 S MANNHEIM RD
Mailing Address - Street 2:STE 1-S
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2544
Mailing Address - Country:US
Mailing Address - Phone:630-330-0157
Mailing Address - Fax:
Practice Address - Street 1:2241 THEODORE STREET
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60432
Practice Address - Country:US
Practice Address - Phone:815-741-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist