Thomas N Stall Sr., DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2830 Issued in SC

Practice address

1100 Village Harbor Dr.
Lake Wylie, SC 29710

Phone

(803) 831-8856

Fax

(803) 831-8966

NPI assigned

Mar 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Lake Wylie Family Dentistry PA

  • Dentist
  • Lake Wylie, SC
  • NPI 1437370798
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124158472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 VILLAGE HARBOR DR.",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "29710",
            "telephone_number": "803-831-8856",
            "fax_number": "803-831-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 VILLAGE HARBOR DR.",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "29710",
            "telephone_number": "803-831-8856",
            "fax_number": "803-831-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALL",
        "first_name": "THOMAS",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "2830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Scott Sullivan
• TLC Your Way Home Care Services, Inc.
• Jennifer C Todd, OT

• Dentist in Lake Wylie, SC
• Providers in Lake Wylie, SC by specialty
• Dentist in South Carolina

• 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.

Verify at the official NPI Registry.