Kenneth Lee Staudt Jr., DDS MPH

Primary specialty

DentistTaxonomy code 122300000X

License

DN00011886 Issued in FL

Practice address

944 Bridgewater Dr
#2B
Port Orange, FL 32129

Phone

(386) 756-8953

Fax

(386) 756-9184

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225258270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "944 BRIDGEWATER DR",
            "address_2": "#2B",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-756-8953",
            "fax_number": "386-756-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "944 BRIDGEWATER DR",
            "address_2": "#2B",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-756-8953",
            "fax_number": "386-756-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUDT",
        "first_name": "KENNETH",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN00011886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Susan Stark, RDH, ORALFACIAL MYOL
• Crystal Starkes
• Michelle Mattera Starkey
• Marcy Starling, ARNP, FNP-BC
• Christopher Tyler Staten
• Steven B Staudt, DMD
• Laura Stearns, MA, CRPS
• Gregory J. Stella, M.D.
• Carl Francesco Stephens, DC
• Mariona Stephens

• Dentist in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Dentist in Florida

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.