Lata Rose Stefano, DDS
Individual provider Active NPI General Practice Dentistry · Sandusky, OH
NPI 1104842301 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104842301
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 20079 (OH)
- Practice address
- 1617 W Bogart Rd
Sandusky, OH 44870-5787 - Phone
- (419) 626-2205
- Fax
- (419) 626-2274
- NPI assigned
- Jul 14, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150615002630 | OH | Order and Referring Only - Oral Surgery |
5294046447 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20079 | OH | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20079 | OH | Yes |
Addresses
Primary practice location
1617 W Bogart Rd
Sandusky, OH 44870-5787
Mailing address
1617 W Bogart Rd
Sandusky, OH 44870-5787
Phone (419) 626-2205
Other providers in Sandusky, OH
- Lynn Anne Stackhouse-Roby
- Sara Stahl
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- State of Ohio Office of Budget and Management State Accounting
- Stay Wellness, Therapy, and Consulting
- Stein Hospice Service Inc
- Stein Hospice Services, Inc
- Stein Hospice Services, Inc
- Charles Stein
- Heather A Stenger
All providers in Sandusky, OH · General Practice Dentistry in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.