1043716863 NPI number — STEGER SMILES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043716863 NPI number — STEGER SMILES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEGER SMILES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STEGER SMILES FAMILY DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043716863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 N CLARK ST UNIT I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60610-8702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-384-9493
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3112 UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEGER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60475-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-754-8090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
NAGARAJ
Authorized Official First Name:
ABHISHEK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
312-384-9493

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019029975 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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