Provider Demographics
NPI:1679668818
Name:RALSTON, STEPHEN JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:RALSTON
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 1:3805 N HIGH ST
Mailing Address - Street 2:STE 207
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:614-262-1807
Mailing Address - Fax:614-262-1721
Practice Address - Street 1:3805 N HIGH ST
Practice Address - Street 2:STE 207
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-262-1807
Practice Address - Fax:614-262-1721
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist