Provider Demographics
NPI:1881861565
Name:STEPHENS DENTISTRY, INC.
Entity Type:Organization
Organization Name:STEPHENS DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-864-8151
Mailing Address - Street 1:1560 SHERMAN AVE
Mailing Address - Street 2:SUITE # 807
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4818
Mailing Address - Country:US
Mailing Address - Phone:847-864-8151
Mailing Address - Fax:847-864-5145
Practice Address - Street 1:1560 SHERMAN AVE
Practice Address - Street 2:SUITE # 807
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4818
Practice Address - Country:US
Practice Address - Phone:847-864-8151
Practice Address - Fax:847-864-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190197401223G0001X
IL0190221191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty