Provider Demographics
NPI:1710331582
Name:DOWELL DENTAL THIRD STREET LLC
Entity Type:Organization
Organization Name:DOWELL DENTAL THIRD STREET LLC
Other - Org Name:DOWELL DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-627-5569
Mailing Address - Street 1:25 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1205
Mailing Address - Country:US
Mailing Address - Phone:330-627-5569
Mailing Address - Fax:
Practice Address - Street 1:25 3RD ST NE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1205
Practice Address - Country:US
Practice Address - Phone:330-627-5569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty