Active NPI
Randy A Stauffer, DDS
- General Practice Dentistry
- Elkhart, IN
National Provider Identifier
1134263114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12009786
- Practice address
- 920 E Mishawaka Rd
Elkhart, IN 46517-3226 - Phone
- (574) 293-3416
- NPI assigned
- Feb 16, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12009786 | IN | Primary |
Addresses
Primary practice location
920 E Mishawaka Rd
Elkhart, IN 46517-3226
Mailing address
920 E Mishawaka Rd
Elkhart, IN 46517-3226
Phone (574) 293-3416
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 |
|---|---|---|---|
| 12009786 | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1134263114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 E MISHAWAKA RD",
"city": "ELKHART",
"state": "IN",
"postal_code": "465173226",
"telephone_number": "574-293-3416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 E MISHAWAKA RD",
"city": "ELKHART",
"state": "IN",
"postal_code": "465173226",
"telephone_number": "574-293-3416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAUFFER",
"first_name": "RANDY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12009786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.