Provider Demographics
NPI:1619407301
Name:BROWN, STEPHEN DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:BROWN
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:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-0418
Mailing Address - Country:US
Mailing Address - Phone:614-436-6444
Mailing Address - Fax:614-436-6596
Practice Address - Street 1:39 GREEN MEADOWS DR S
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9455
Practice Address - Country:US
Practice Address - Phone:614-436-6444
Practice Address - Fax:614-436-6596
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice