Active NPI
Tyrone Harold Stevens
- Dentist
- Charlotte, NC
National Provider Identifier
1083374623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 000008606466
- Practice address
- 3129 Tacoma St
Charlotte, NC 28208-2681 - Phone
- (601) 336-2669
- NPI assigned
- Dec 22, 2021
- 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 | 000008606466 | NC | Primary |
Addresses
Primary practice location
3129 Tacoma St
Charlotte, NC 28208-2681
Mailing address
3129 Tacoma St
Charlotte, NC 28208-2681
Phone (601) 336-2669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000008606466 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000008606466 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640131200000",
"number": "1083374623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3129 TACOMA ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282082681",
"telephone_number": "601-336-2669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3129 TACOMA ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282082681",
"telephone_number": "601-336-2669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENS",
"first_name": "TYRONE",
"middle_name": "HAROLD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-22",
"last_updated": "2021-12-22",
"certification_date": "2021-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "000008606466",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000008606466",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.