Provider Demographics
NPI:1902319155
Name:OHIO DENTAL ASSOCIATES BRIAN C. STICKEL DDS, LLC
Entity Type:Organization
Organization Name:OHIO DENTAL ASSOCIATES BRIAN C. STICKEL DDS, LLC
Other - Org Name:NEWARK DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-942-6004
Mailing Address - Street 1:7874 SILVER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7740
Mailing Address - Country:US
Mailing Address - Phone:614-942-6004
Mailing Address - Fax:
Practice Address - Street 1:1339 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1821
Practice Address - Country:US
Practice Address - Phone:740-344-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental