Active NPI
Stuart Hall Whiddon, D.D.S.
- Dentist
- Greensboro, NC
National Provider Identifier
1063633485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4824
- Practice address
- 3802 Gaston Rd
Greensboro, NC 27407-7759 - Phone
- (336) 430-6922
- NPI assigned
- May 1, 2007
- Last updated
- Sep 7, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4824 | NC | Primary |
Addresses
Primary practice location
3802 Gaston Rd
Greensboro, NC 27407-7759
Mailing address
3802 Gaston Rd
Greensboro, NC 27407-7759
Phone (336) 430-6922
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 899203 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150304000647 | NC | Order and Referring Only - Other (Non-Physician) | 4183940471 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60073 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1063633485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3802 GASTON RD",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274077759",
"telephone_number": "336-430-6922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3802 GASTON RD",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274077759",
"telephone_number": "336-430-6922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHIDDON",
"first_name": "STUART",
"middle_name": "HALL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "4824",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "899203",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.