Provider Demographics
NPI:1407852890
Name:DOWELL, STEPHEN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:DOWELL
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 1:549 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1003
Mailing Address - Country:US
Mailing Address - Phone:330-627-5005
Mailing Address - Fax:330-627-5982
Practice Address - Street 1:549 2ND ST NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1003
Practice Address - Country:US
Practice Address - Phone:330-627-5005
Practice Address - Fax:330-627-5982
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
OH191731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812419Medicaid