Active NPI
Phillip Wayne Steen, DDS
- Dentist
- Macclenny, FL
National Provider Identifier
1215078506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10644
- Practice address
- 480 W Lowder St
Macclenny, FL 32063-2664 - Phone
- (904) 259-6291
- Fax
- (904) 259-4761
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10644 | FL | Primary |
Addresses
Primary practice location
480 W Lowder St
Macclenny, FL 32063-2664
Mailing address
480 W Lowder St
Macclenny, FL 32063-2664
Phone (904) 259-6291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0763659 | Medicaid | FL |
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 |
|---|---|---|---|
| 10644 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358985600000",
"number": "1215078506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "480 W LOWDER ST",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320632664",
"telephone_number": "904-259-6291",
"fax_number": "904-259-4761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 W LOWDER ST",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320632664",
"telephone_number": "904-259-6291",
"fax_number": "904-259-4761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEEN",
"first_name": "PHILLIP",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2013-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "10644",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0763659",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.