Provider Demographics
NPI:1033103585
Name:STEPHENS, ROBERT BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2525
Mailing Address - Country:US
Mailing Address - Phone:847-864-8151
Mailing Address - Fax:
Practice Address - Street 1:1560 SHERMAN AVENUE SUITE # 807
Practice Address - Street 2:STEPHENS DENTISTRY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4808
Practice Address - Country:US
Practice Address - Phone:847-864-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice