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General NPI Number Information
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NPI Number | 1811323751
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Entity Type | Individual
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Provider Name | STEPHEN POWELL D.D.S., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 2501 CASON ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2806
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Country | US
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Telephone | 765-447-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 9221 GRINNELL ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1233
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Country | US
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Telephone |
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12011511A
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License Number State | IN
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