Healthcare Provider Details

I. General information

NPI: 1497730196
Provider Name (Legal Business Name): ORVILLE JOHN STEIN JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W JOHN FITCH AVE
BARDSTOWN KY
40004-1115
US

IV. Provider business mailing address

218 W JOHN FITCH AVE
BARDSTOWN KY
40004-1115
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-9775
  • Fax:
Mailing address:
  • Phone: 502-348-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7256
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7256 898
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: