Healthcare Provider Details

I. General information

NPI: 1184126096
Provider Name (Legal Business Name): EBER LUIS LIMA STEVAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 CROSS CREEKS BLVD
PICKERINGTON OH
43147-8237
US

IV. Provider business mailing address

1575 CROSS CREEKS BLVD
PICKERINGTON OH
43147-8237
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-7500
  • Fax: 614-322-7900
Mailing address:
  • Phone: 614-751-7500
  • Fax: 614-322-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number30025316
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30025316
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30025316
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: