Provider Demographics
NPI:1356428734
Name:EDIDIN, STEVEN D (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:EDIDIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 OLD ORCHARD PROF BLDG
Mailing Address - Street 2:SUITE #300
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-674-0608
Mailing Address - Fax:847-674-0940
Practice Address - Street 1:64 OLD ORCHARD PROF BLDG
Practice Address - Street 2:SUITE #300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-674-0608
Practice Address - Fax:847-674-0940
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice