Provider Demographics
NPI:1326119280
Name:POOLEY, STEVEN D (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:POOLEY
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 1:7318 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3902
Mailing Address - Country:US
Mailing Address - Phone:815-968-5434
Mailing Address - Fax:815-968-5475
Practice Address - Street 1:7318 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3902
Practice Address - Country:US
Practice Address - Phone:815-968-5434
Practice Address - Fax:815-968-5475
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice