MEDICARE: NATALIA STEPANOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	16889	MD

General Provider Information

NPI Number	:	1790248680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA STEPANOVA

Provider Business Mailing Address
First Line	:	1065 W. PERIMITER RD
Second Line	:
City	:	JB ANDREWS
State	:	MD
Zip	:	20762
Country	:	US
Telephone Number	:	240-612-2369
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 13TH ST APT 413
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5821
Country	:	US
Telephone Number	:	240-476-7955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	11/06/2019

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Directions to “ NATALIA STEPANOVA ” Practice Location

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