Active NPI
Sean Stevenson
- Dentist
- Gilbert, AZ
National Provider Identifier
1124401633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9362
- Practice address
- 3877 S Gilbert Rd
Gilbert, AZ 85297-2178 - Phone
- (480) 498-4294
- NPI assigned
- Jul 1, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9362 | AZ | Primary |
| Dentist | 122300000X | 6751 | OK |
Addresses
Primary practice location
3877 S Gilbert Rd
Gilbert, AZ 85297-2178
Mailing address
3877 S Gilbert Rd
Gilbert, AZ 85297-2178
Phone (480) 498-4294
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20170116000727 | AZ | Order and Referring Only - Dentist | 1658653282 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9362 | AZ | MD | Dentist |
| 6751 | OK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463097600000",
"number": "1124401633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3877 S GILBERT RD",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852972178",
"telephone_number": "480-498-4294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3877 S GILBERT RD",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852972178",
"telephone_number": "480-498-4294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-01",
"last_updated": "2016-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "9362",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "6751",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; 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.