Individual
STEPHANIE BOLLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-7532
Mailing address
801 S PAULINA ST RM 256D, CHICAGO, IL 60612-7210
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
021.003194
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2020
Last updated
01/20/2023
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