Provider Demographics
NPI:1265520340
Name:KOOS, STEVEN ANTHONY (MD DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:KOOS
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 BETHANY RD
Mailing Address - Street 2:STE A
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178
Mailing Address - Country:US
Mailing Address - Phone:815-895-3000
Mailing Address - Fax:815-895-0505
Practice Address - Street 1:1675 BETHANY RD
Practice Address - Street 2:STE A
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-895-3000
Practice Address - Fax:815-895-0505
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223S0112X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79499Medicare UPIN
L97551Medicare ID - Type Unspecified