Individual provider Active NPI

Steve A Gwaltney, D.D.S.

  • General Practice Dentistry
  • Suffolk, VA
National Provider Identifier
1083626030
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401006166 Issued in VA
Practice address
2486 Pruden Blvd
Suffolk, VA 23434-4206
Phone
(757) 539-3021
Fax
(757) 539-6262
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401006166 VA Primary

Addresses

Primary practice location

2486 Pruden Blvd
Suffolk, VA 23434-4206

Mailing address

2486 Pruden Blvd
Suffolk, VA 23434-4206
Phone (757) 539-3021

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150702001939 VA Order and Referring Only - Other (Non-Physician) 4284946336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Steve a Gwaltney, DDS PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083626030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2486 PRUDEN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344206",
            "telephone_number": "757-539-3021",
            "fax_number": "757-539-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2486 PRUDEN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344206",
            "telephone_number": "757-539-3021",
            "fax_number": "757-539-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWALTNEY",
        "first_name": "STEVE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401006166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.