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General NPI Number Information
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NPI Number | 1841301918
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Entity Type | Organization
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Legal Business Name | STEPHEN J. DOELKER DDS LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 497 W MAIN ST
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City | BATAVIA
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State | OH
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Zip | 45103
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Country | US
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Telephone | 513-735-9111
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Fax | 513-735-9222
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Provider Business Mailing Address
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Address Line | 497 W MAIN ST
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City | BATAVIA
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State | OH
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Zip | 45103
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Country | US
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Telephone | 513-735-9111
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Fax | 513-735-9222
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. WILLIAM R FRY JR.
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Credential | MBA
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Telephone | 513-735-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30013796
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License Number State | OH
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