Active NPI
Mysty Shaver, DDS
- Dentist
- Ankeny, IA
National Provider Identifier
1235510421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9192
- Practice address
- 1225 SW State St
Ankeny, IA 50023-2545 - Phone
- (515) 964-8350
- NPI assigned
- Jun 12, 2015
- Last updated
- Oct 14, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9192 | IA | Primary |
| General Practice Dentistry | 1223G0001X | DDS-09192 | IA |
Addresses
Primary practice location
1225 SW State St
Ankeny, IA 50023-2545
Mailing address
1225 SW State St
Ankeny, IA 50023-2545
Phone (515) 964-8350
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 |
|---|---|---|---|
| 9192 | IA | MD | Dentist |
| DDS-09192 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728864000000",
"number": "1235510421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 SW STATE ST",
"city": "ANKENY",
"state": "IA",
"postal_code": "500232545",
"telephone_number": "515-964-8350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 SW STATE ST",
"city": "ANKENY",
"state": "IA",
"postal_code": "500232545",
"telephone_number": "515-964-8350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAVER",
"first_name": "MYSTY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-12",
"last_updated": "2024-10-14",
"certification_date": "2024-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "9192",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "DDS-09192",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ankeny, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.