NPIMap

Individual provider Active NPI

Steven John Staley, DDS

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1225046345
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3483 Issued in ID
Practice address
1029 E Park Blvd
Suite #100
Boise, ID 83712
Phone
(208) 344-9054
Fax
(208) 422-0217
NPI assigned
Aug 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3483 ID Primary

Addresses

Primary practice location

1029 E Park Blvd
Suite #100
Boise, ID 83712

Mailing address

1029 E Park Blvd
Suite #100
Boise, ID 83712
Phone (208) 344-9054

Other names 1

  • Dr. S John Staley Professional name

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

LicenseStateTypeSpecialty
D3483IDMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1225046345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 E PARK BLVD",
            "address_2": "SUITE #100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83712",
            "telephone_number": "208-344-9054",
            "fax_number": "208-422-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 E PARK BLVD",
            "address_2": "SUITE #100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83712",
            "telephone_number": "208-344-9054",
            "fax_number": "208-422-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "STEVEN",
        "middle_name": "JOHN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "S",
            "last_name": "STALEY",
            "middle_name": "JOHN",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.