Individual provider Active NPI

Daisy N Stojanov, BDS, MSD

  • Endodontics
  • Beachwood, OH
National Provider Identifier
1083005540
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
30.025210 Issued in OH
Practice address
23250 Mercantile Rd Ste 110N
Beachwood, OH 44122-5928
Phone
(216) 577-0319
NPI assigned
Feb 5, 2015
Last updated
Sep 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 30.025210 OH Primary
Student in an Organized Health Care Education/Training Program 390200000X RES3522 OH

Addresses

Primary practice location

23250 Mercantile Rd Ste 110N
Beachwood, OH 44122-5928

Mailing address

23250 Mercantile Rd, Suite 110N
Beachwood, OH 44122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20170830000982 OH Order and Referring Only - DentistPractitioner - Dentist 6800169624

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RES3522OHMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1423094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1083005540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23250 MERCANTILE RD, SUITE 110N",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "44122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23250 MERCANTILE RD STE 110N",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225928",
            "telephone_number": "216-577-0319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOJANOV",
        "first_name": "DAISY",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "BDS, MSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-05",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OH",
            "license": "30.025210",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "RES3522",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

Verify at the official NPI Registry.