Provider Demographics
NPI:1558450999
Name:STEPHEN M MUSICK DDS INC
Entity Type:Organization
Organization Name:STEPHEN M MUSICK DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-898-1811
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9179980OtherDORAL DENTAL UNISON
OH0266975Medicaid
OH0266975Medicaid