Provider Demographics
NPI:1639608854
Name:STERN, ABIGAIL LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:LYNN
Last Name:STERN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:LYNN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:811 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5123
Mailing Address - Country:US
Mailing Address - Phone:773-871-6138
Mailing Address - Fax:
Practice Address - Street 1:6307 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-962-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist