Provider Demographics
NPI:1861948374
Name:SCHELKOPF, STUART (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:SCHELKOPF
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 1:222 N LASALLE ST
Mailing Address - Street 2:STE 230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:815-757-5253
Mailing Address - Fax:
Practice Address - Street 1:222 N LASALLE ST
Practice Address - Street 2:STE 230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-704-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029966122300000X
IL019.0299661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist