Provider Demographics
NPI:1497814420
Name:LISS, STEPHANIE P (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:P
Last Name:LISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4772
Mailing Address - Country:US
Mailing Address - Phone:773-581-1345
Mailing Address - Fax:773-581-0013
Practice Address - Street 1:5200 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4772
Practice Address - Country:US
Practice Address - Phone:773-581-1345
Practice Address - Fax:773-581-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist