Active NPI
Lata Rose Stefano, DDS
- General Practice Dentistry
- Sandusky, OH
National Provider Identifier
1104842301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 20079
- Practice address
- 1617 W Bogart Rd
Sandusky, OH 44870-5787 - Phone
- (419) 626-2205
- Fax
- (419) 626-2274
- NPI assigned
- Jul 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20079 | OH | Primary |
Addresses
Primary practice location
1617 W Bogart Rd
Sandusky, OH 44870-5787
Mailing address
1617 W Bogart Rd
Sandusky, OH 44870-5787
Phone (419) 626-2205
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150615002630 | OH | Order and Referring Only - Oral Surgery | 5294046447 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20079 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104842301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1617 W BOGART RD",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448705787",
"telephone_number": "419-626-2205",
"fax_number": "419-626-2274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1617 W BOGART RD",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448705787",
"telephone_number": "419-626-2205",
"fax_number": "419-626-2274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEFANO",
"first_name": "LATA",
"middle_name": "ROSE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "20079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandusky, OH
- Lynn Anne Stackhouse-Roby, APRN, DNP
- Sara Stahl, LSW
- Star Chiropractic LLC
- State of Ohio Office of Budget and Management State Accounting (Ohio Veterans Home)
- Stay Wellness, Therapy, and Consulting (Stay Wellness)
- Stein Hospice Service Inc
- Stein Hospice Services, Inc
- Stein Hospice Services, Inc (Stein Palliative Medicine)
- Charles Stein, PT
- Heather A Stenger, MFT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.