Provider Demographics
NPI:1568653483
Name:STEPHENS, BRANDI NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 E. MAIN STREET
Mailing Address - Street 2:SUITE 810
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-231-8102
Mailing Address - Fax:614-231-4801
Practice Address - Street 1:3646 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-231-8102
Practice Address - Fax:614-231-4801
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice