Healthcare Provider Details

I. General information

NPI: 1225732795
Provider Name (Legal Business Name): STEPHEN M HAVERKOS DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5754 BRIDGETOWN RD
CINCINNATI OH
45248-3100
US

IV. Provider business mailing address

5754 BRIDGETOWN RD
CINCINNATI OH
45248-3100
US

V. Phone/Fax

Practice location:
  • Phone: 513-481-8000
  • Fax:
Mailing address:
  • Phone: 513-481-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN M HAVERKOS
Title or Position: OWNER, ORTHODONTIST
Credential: DMD
Phone: 513-481-8000