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General NPI Number Information
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NPI Number | 1023468352
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Entity Type | Individual
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Provider Name | STEPHANIE A NGUYEN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 2650 RIDGE AVE SUITE 1304
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City | EVANSTON
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State | IL
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Zip | 60201-1718
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Country | US
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Telephone | 847-570-2369
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR SUITE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-7594
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Country | US
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Telephone | 773-702-1150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 018001996
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License Number State | IL
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