Healthcare Provider Details

I. General information

NPI: 1215860820
Provider Name (Legal Business Name): KOLBEIN STEVENS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE ST STE 140
OAK PARK IL
60301-6712
US

IV. Provider business mailing address

6000 E LAKE DR APT 2D
LISLE IL
60532-3046
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-1234
  • Fax:
Mailing address:
  • Phone: 630-520-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: