Provider Demographics
NPI:1477622801
Name:STEINBERG, MARK J (MD DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:STEINBERG
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(EMS BLDG., RM. 2700)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-327-2700
Mailing Address - Fax:708-327-3474
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(EMS BLDG., RM. 2700)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-327-2700
Practice Address - Fax:708-327-3474
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075892208600000X
IL0190167661223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C90843Medicare UPIN