Provider Demographics
NPI:1750481115
Name:PALATINUS, STEPHEN
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:PALATINUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5238
Mailing Address - Country:US
Mailing Address - Phone:708-562-8660
Mailing Address - Fax:
Practice Address - Street 1:10550 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5238
Practice Address - Country:US
Practice Address - Phone:708-562-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190223331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice