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NPI 1568653483

NPI 1568653483 : BRANDI NICOLE STEPHENS DDS : WHITEHALL, OH

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General NPI Number Information
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    NPI Number           |    1568653483
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    Entity Type          |    Individual 
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    Provider Name        |    BRANDI NICOLE STEPHENS DDS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    08/06/2007
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    Last Update Date     |    07/26/2011
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Provider Practice Location Address
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    Address Line         |    3646 E. MAIN STREET 
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    City                 |    WHITEHALL
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    State                |    OH
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    Zip                  |    43213
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    Country              |    US
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    Telephone            |    614-231-8102
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    Fax                  |    614-231-4801
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Provider Business Mailing Address
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    Address Line         |    3646 E. MAIN STREET SUITE 810
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    City                 |    WHITEHALL
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    State                |    OH
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    Zip                  |    43213
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    Country              |    US
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    Telephone            |    614-231-8102
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    Fax                  |    614-231-4801
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    23522
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    License Number State |    TX
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