Basic Information
| Provider Information | |||||||||
| NPI: | 1568653483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3646 E. MAIN STREET | ||||||||
| Address2: | SUITE 810 | ||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142318102 | ||||||||
| FaxNumber: | 6142314801 | ||||||||
| Practice Location | |||||||||
| Address1: | 3646 E. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142318102 | ||||||||
| FaxNumber: | 6142314801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 23522 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.