Stefanus Siswanto DDS PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22440 Issued in TX

Legal business name

STEFANUS SISWANTO DDS PLLC

Doing business as

Midway Family Dentistry

Practice address

18181 Midway Rd Ste 500
Dallas, TX 75287-8104

Phone

(214) 934-2198

NPI assigned

May 6, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Stefanus H Siswanto, DDSNPI 1033271879

Title

President

Phone

(214) 934-2198

Specialties & licenses 1

Addresses

Other names 1

• Midway Family Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stefanus H Siswanto, DDS

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1033271879
  NPD (past) Authorized official

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1033385497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18181 MIDWAY RD STE 500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752878104"
        },
        {
            "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": "214-934-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEFANUS SISWANTO DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "SISWANTO",
        "authorized_official_first_name": "STEFANUS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-934-2198",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midway Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric M Steen, MD
• Stephanie Ann Steets, AGACNP
• Molly Elizabeth Steeves
• Stefanie J. McCann MD PA
• Molly Stefanski
• Haden A. Steffek, M.D.
• Clark Wilson Steffens I, DDS
• Matthew Ryan Steffer, D.D.S.
• Clinton Scott Steffey, M.D.
• Daniel Mackenzie Stegall

• 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 May 6, 2008; 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.