Healthcare Provider Details

I. General information

NPI: 1386443075
Provider Name (Legal Business Name): TANNER STEPHEN HAUPTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 E RAND RD STE 200
ARLINGTON HEIGHTS IL
60004-4359
US

IV. Provider business mailing address

274 N JACKSON RD
CLARENDON HILLS IL
60514-1025
US

V. Phone/Fax

Practice location:
  • Phone: 847-870-8820
  • Fax:
Mailing address:
  • Phone: 720-935-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019036988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: