1679792360 NPI number — DR. ROBERT BENJAMIN STEVENSON III DDS MS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679792360 NPI number — DR. ROBERT BENJAMIN STEVENSON III DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENSON
Provider First Name:
ROBERT
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679792360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 OLENTANGY RIVER ROAD
Provider Second Line Business Mailing Address:
SUITE D3
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-451-2767
Provider Business Mailing Address Fax Number:
614-451-2988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 OLENTANGY RIVER ROAD
Provider Second Line Business Practice Location Address:
SUITE D3
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-451-2767
Provider Business Practice Location Address Fax Number:
614-451-2988
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  15347 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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