Provider Demographics
NPI:1275721631
Name:STICKEL, BRIAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:STICKEL
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 1:877 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3309
Mailing Address - Country:US
Mailing Address - Phone:614-882-1135
Mailing Address - Fax:614-882-4911
Practice Address - Street 1:877 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3309
Practice Address - Country:US
Practice Address - Phone:614-882-1135
Practice Address - Fax:614-882-4911
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201384722OtherTAX ID