Stillwater Dentistry PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STILLWATER DENTISTRY PLLC

Practice address

1963 Robert St S Ste 100
West St Paul, MN 55118-3942

Phone

(651) 321-1007

NPI assigned

Sep 28, 2017

Last updated

Sep 28, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hassan Ismail

Title

Owner

Phone

(651) 321-1007

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506556800000",
    "number": "1154830602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1963 ROBERT ST S STE 100",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551183942",
            "telephone_number": "651-321-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-28",
        "last_updated": "2017-09-28",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-321-1007"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.