NPIMap

Organization Active NPI

John W Stevens DDS PC

  • General Practice Dentistry
  • Willimantic, CT
National Provider Identifier
1053000505
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
JOHN W STEVENS DDS PC
Practice address
1581 Main St
Willimantic, CT 06226-1129
Phone
(860) 456-3214
NPI assigned
May 2, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

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

Authorized official

Name
Nickalus Stevens, DMDNPI 1215601687
Title
Dentist and Owner
Phone
(860) 933-3789

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1581 Main St
Willimantic, CT 06226-1129

Mailing address

1581 Main St
Willimantic, CT 06226-1129
Phone (860) 456-3214

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1682985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682985600000",
    "number": "1053000505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1581 MAIN ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261129",
            "telephone_number": "860-456-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1581 MAIN ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261129",
            "telephone_number": "860-456-3214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN W STEVENS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-02",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "NICKALUS",
        "authorized_official_title_or_position": "DENTIST AND OWNER",
        "authorized_official_telephone_number": "860-933-3789",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.