Individual provider Active NPI

Sanford Gray Stephens, D.D.S.

  • General Practice Dentistry
  • Monroe, LA
National Provider Identifier
1043391691
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3738 Issued in LA
Practice address
2223 Justice St
Monroe, LA 71201-3619
Phone
(318) 323-0240
Fax
(318) 322-7348
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3738 LA Primary

Addresses

Primary practice location

2223 Justice St
Monroe, LA 71201-3619

Mailing address

2223 Justice St
Monroe, LA 71201-3619
Phone (318) 323-0240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617000462 LA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7416268479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3738LAMDCounselor

Networks

  • LA PPO C-SNP

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043391691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 JUSTICE ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013619",
            "telephone_number": "318-323-0240",
            "fax_number": "318-322-7348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 JUSTICE ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013619",
            "telephone_number": "318-323-0240",
            "fax_number": "318-322-7348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "SANFORD",
        "middle_name": "GRAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "3738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.