Provider Demographics
NPI:1215037072
Name:MUSICK, STEPHEN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MUSICK
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 1:2760 PARKMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485
Mailing Address - Country:US
Mailing Address - Phone:330-898-1811
Mailing Address - Fax:330-898-7056
Practice Address - Street 1:2760 PARKMAN RD NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485
Practice Address - Country:US
Practice Address - Phone:330-898-1811
Practice Address - Fax:330-898-7056
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341266183027OtherCARESOURCE
OH9179980OtherDORAL DENTAL UNISON
OH0266975Medicaid