Jacob Tant Stinson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

210383 Issued in AK

Practice address

1551 W Parks Hwy
Wasilla, AK 99654-6933

Phone

(907) 357-6684

NPI assigned

Jun 28, 2023

Last updated

Jun 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aesthetic Dental Group LLC

  dba Aesthetic Family Dentistry

  • Dental Clinic/Center
  • Wasilla, AK
  • NPI 1003539008
  NPD
• Aesthetic Family Dentistry

  • Dentist
  • Wasilla, AK
  • NPI 1265673008
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1013694462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 W PARKS HWY",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546933",
            "telephone_number": "907-357-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 W PARKS HWY",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546933",
            "telephone_number": "907-357-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STINSON",
        "first_name": "JACOB",
        "middle_name": "TANT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "210383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.