MEDICARE: S. C. DOWELL, DDS, LLC

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	19173	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	:	1598178741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. C. DOWELL, DDS, LLC

Provider Business Mailing Address
First Line	:	615 N MARKET ST
Second Line	:
City	:	MINERVA
State	:	OH
Zip	:	44657-1003
Country	:	US
Telephone Number	:	330-868-5080
Fax Number	:	330-868-7812

Provider Business Practice Location Address
First Line	:	549 2ND ST NW
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-1003
Country	:	US
Telephone Number	:	330-627-5005
Fax Number	:	330-627-5982

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN C. DOWELL
Credential	:	D.D.S.
Telephone Number	:	330-627-5005

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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