Provider Demographics
NPI:1316070634
Name:STEIN, JAMES ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:STEIN
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 1:1640 N WELLS ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6087
Mailing Address - Country:US
Mailing Address - Phone:312-642-4217
Mailing Address - Fax:312-642-9058
Practice Address - Street 1:1640 N WELLS ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6087
Practice Address - Country:US
Practice Address - Phone:312-642-4217
Practice Address - Fax:312-642-9058
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist