Active NPI
Stephanie Mary Ann Souza, DMD
- General Practice Dentistry
- Medford, MA
National Provider Identifier
1205680188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN10000253
- Practice address
- 8 Earhart LNDG
Medford, MA 02155-4964 - Phone
- (617) 301-3628
- NPI assigned
- Apr 16, 2024
- 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 | DN10000253 | MA | Primary |
Addresses
Primary practice location
8 Earhart LNDG
Medford, MA 02155-4964
Mailing address
8 Earhart LNDG
Medford, MA 02155-4964
Phone (617) 301-3628
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 |
|---|---|---|---|
| DN10000253 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718928000000",
"number": "1205680188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 EARHART LNDG",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554964",
"telephone_number": "617-301-3628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 EARHART LNDG",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554964",
"telephone_number": "617-301-3628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUZA",
"first_name": "STEPHANIE",
"middle_name": "MARY ANN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-16",
"last_updated": "2024-06-21",
"certification_date": "2024-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN10000253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.