Provider Demographics
NPI:1225732795
Name:STEPHEN M HAVERKOS DMD LLC
Entity Type:Organization
Organization Name:STEPHEN M HAVERKOS DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAVERKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-481-8000
Mailing Address - Street 1:5754 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-3100
Mailing Address - Country:US
Mailing Address - Phone:513-481-8000
Mailing Address - Fax:
Practice Address - Street 1:5754 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-3100
Practice Address - Country:US
Practice Address - Phone:513-481-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental