=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831761147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUREN STEVENOT, DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2021
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 BONNELL ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-563-6936
-----------------------------------------------------
Fax | 513-563-1008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 BONNELL ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-563-6936
-----------------------------------------------------
Fax | 513-563-1008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAUREN ANGELINA STEVENOT
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 937-672-3515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------