Provider Demographics
NPI:1881768729
Name:KLERONOMOS, STEVE JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:JAMES
Last Name:KLERONOMOS
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 1:8000 KILPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3013
Mailing Address - Country:US
Mailing Address - Phone:847-677-0129
Mailing Address - Fax:
Practice Address - Street 1:8301 S BRANDON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2656
Practice Address - Country:US
Practice Address - Phone:773-375-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190196571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002547Medicaid