Provider Demographics
NPI:1811490337
Name:PRIEVE, STEPHEN ROSS (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROSS
Last Name:PRIEVE
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 1:16655 W BLUEMOUND RD STE 380
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5939
Mailing Address - Country:US
Mailing Address - Phone:262-786-1270
Mailing Address - Fax:
Practice Address - Street 1:220 KEENAN COURT
Practice Address - Street 2:SUITE #100
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593
Practice Address - Country:US
Practice Address - Phone:608-960-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-11
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-097281223P0221X
MD164741223P0221X
WI60010811223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid