Provider Demographics
NPI:1619059268
Name:MAHANY, STEVEN J (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MAHANY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11407 N ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9218
Mailing Address - Country:US
Mailing Address - Phone:309-243-7054
Mailing Address - Fax:
Practice Address - Street 1:9016 N ALLEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1513
Practice Address - Country:US
Practice Address - Phone:309-690-4500
Practice Address - Fax:309-691-7298
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190172321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice