MEDICARE: DR. STEPHEN S. FENSTEMAKER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	01-8734	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144212390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN S. FENSTEMAKER D.D.S.

Provider Business Mailing Address
First Line	:	309 SHERBAN CT
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-1369
Country	:	US
Telephone Number	:	330-875-2832
Fax Number	:	330-875-2492

Provider Business Practice Location Address
First Line	:	309 SHERBAN CT
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-1369
Country	:	US
Telephone Number	:	330-875-2832
Fax Number	:	330-875-2492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/23/2008

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