Provider Demographics
NPI:1881920445
Name:STEPHEN C. DOWELL DDS, LLC
Entity type:Organization
Organization Name:STEPHEN C. DOWELL DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:330-868-5001
Mailing Address - Street 1:817 E LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1211
Mailing Address - Country:US
Mailing Address - Phone:330-868-5001
Mailing Address - Fax:
Practice Address - Street 1:817 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1211
Practice Address - Country:US
Practice Address - Phone:330-868-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN C. DOWELL DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812419Medicaid