Stefanus H Siswanto, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22440 Issued in TX

Practice address

18181 Midway Rd Ste 500
Dallas, TX 75287-8104

Phone

(972) 306-5000

Fax

(972) 306-5009

NPI assigned

Dec 15, 2006

Last updated

Jul 20, 2009By 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

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.

• Stefanus Siswanto DDS PLLC

  dba Midway Family Dentistry

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1033385497
  NPD (past) Authorized official

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248048000000",
    "number": "1033271879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5304 SAINT CROIX CT",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750824134",
            "telephone_number": "972-881-3757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18181 MIDWAY RD STE 500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752878104",
            "telephone_number": "972-306-5000",
            "fax_number": "972-306-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISWANTO",
        "first_name": "STEFANUS",
        "middle_name": "H",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2009-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Marie Sisk, OTR
• Matthew Robert Siskowski, MD
• Jacob Orth Sisombath, D.D.S.
• Stephen Charles Sissons, RN
• Emily Siswanto, PHARMD
• Amreen Sitabkhan
• Amy Sitabkhan, OTR
• Sitbatmne LLC (HavenFuse IV Center)
• Gerald Sithole
• Sitl of Texas LLC Skys the Limit

• General Practice Dentistry in Dallas, TX
• Providers in Dallas, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2009; 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.