Provider Demographics
NPI:1417000274
Name:WARD, STEPHANIE MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:WARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:WARD-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2345 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3811
Mailing Address - Country:US
Mailing Address - Phone:773-579-0500
Mailing Address - Fax:773-579-0335
Practice Address - Street 1:2345 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3811
Practice Address - Country:US
Practice Address - Phone:773-579-0500
Practice Address - Fax:773-579-0335
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190257601223G0001X
IL3190144161223G0001X
ILBW80419391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice