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General NPI Number Information
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NPI Number | 1770527475
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Entity Type | Individual
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Provider Name | STEVEN DANIEL HENNESSY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 3722 S. HARLEM AVE SUITE 203
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City | RIVERSIDE
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State | IL
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Zip | 60546-2334
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Country | US
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Telephone | 708-442-5657
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Fax | 708-442-0362
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Provider Business Mailing Address
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Address Line | 1071 DEVONSHIRE AVE
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City | NAPERVILLE
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State | IL
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Zip | 60540-6271
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Country | US
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Telephone | 630-561-3538
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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 | 9819
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019019744
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License Number State | IL
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