Individual provider Active NPI

Steven Dennis Destler, D.D.S.

  • Dentist
  • Ventura, CA
National Provider Identifier
1053547406
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
41396 Issued in CA
Practice address
2533 E Main St
Ventura, CA 93003-2618
Phone
(805) 643-0700
Fax
(805) 643-6816
NPI assigned
May 29, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 41396 CA Primary

Addresses

Primary practice location

2533 E Main St
Ventura, CA 93003-2618

Mailing address

2533 E Main St
Ventura, CA 93003-2618
Phone (805) 643-0700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20210122002245 CA Practitioner - Oral Surgery 4688088255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41396CAMDContractor

Practice roles

OrganizationSpecialtyStatusNew patients
A Sabbagh-Fard DDS & P. Mastour DDS Inc Dentist CurrentSince Sep 22, 2020 Accepting new patients
Steven Destler DDS Dental Corporation CurrentSince Apr 30, 2023 Accepting new patients
Fard & Mastour Dental Group Dentist PastSince Sep 22, 2020 Accepting new patients
Mastour & Fard Dental Corp PastSince Sep 22, 2020 Accepting new patients

Locations

5620 Sawtelle Blvd
Culver City, CA 90230
Phone (310) 390-6212

2533 E Main St
Ventura, CA 93003
Phone (805) 643-0700

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1053547406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2533 E MAIN ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032618",
            "telephone_number": "805-643-0700",
            "fax_number": "805-643-6816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2533 E MAIN ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032618",
            "telephone_number": "805-643-0700",
            "fax_number": "805-643-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTLER",
        "first_name": "STEVEN",
        "middle_name": "DENNIS",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-29",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.