Active NPI
Diana Stepanova, DDS
- General Practice Dentistry
- Coeur D Alene, ID
National Provider Identifier
1245072040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D-5630
- Practice address
- 2344 N Merritt Creek Loop
Coeur D Alene, ID 83814-4950 - Phone
- (208) 457-7137
- NPI assigned
- Jun 11, 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 | D-5630 | ID | Primary |
Addresses
Primary practice location
2344 N Merritt Creek Loop
Coeur D Alene, ID 83814-4950
Mailing address
791 E Southwood CT
Hayden, ID 83835-6960
Phone (208) 957-4675
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 |
|---|---|---|---|
| D-5630 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718409600000",
"number": "1245072040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "791 E SOUTHWOOD CT",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838356960",
"telephone_number": "208-957-4675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2344 N MERRITT CREEK LOOP",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838144950",
"telephone_number": "208-457-7137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPANOVA",
"first_name": "DIANA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-11",
"last_updated": "2024-06-15",
"certification_date": "2024-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D-5630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.