=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790248680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIA STEPANOVA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 11/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8025 13TH ST APT 413
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-5821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-476-7955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1065 W. PERIMITER RD
-----------------------------------------------------
City | JB ANDREWS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-612-2369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 16889
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------