Stephanie A Myles, DMD
Individual provider Active NPI General Practice Dentistry · Wilmington, NC
NPI 1255484309 · NPPES record last updated May 19, 2015
Key facts
- NPI
- 1255484309
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS028954L (PA)
- Practice address
- 404 S College Rd
Wilmington, NC 28403-1604 - Phone
- (910) 228-5600
- Fax
- (910) 769-3495
- NPI assigned
- Jan 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160827000153 | NC | Order and Referring Only - Oral Surgery |
8426343534 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS028954L | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephanie Myles PC | General Practice | Past | Accepting new patients |
| Stephanie Myles PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS028954L | PA | Yes |
Addresses
Primary practice location
404 S College Rd
Wilmington, NC 28403-1604
Mailing address
PO Box 12127
Wilmington, NC 28405-0107
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001483378 | Medicaid | PA |
NPI Registry JSON
{
"created_epoch": "1169251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431993600000",
"number": "1255484309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12127",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284050107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 S COLLEGE RD",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284031604",
"telephone_number": "910-228-5600",
"fax_number": "910-769-3495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYLES",
"first_name": "STEPHANIE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-20",
"last_updated": "2015-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS028954L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001483378",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
- Myeyedr Optometry of North Carolina PLLC
- Myeyedr Optometry of North Carolina PLLC
- Myeyedr Optometry of North Carolina, PLLC
- Myeyedr Optometry of North Carolina, PLLC
- Jolea Lewis Myles
- Myrtle Grove Chiropractic, PA
- Myrtle Grove Optical, LLC
- Kathryn Louise Myslinski
- Menaka M Nadar
- Gowd Shiva Nagaraj
All providers in Wilmington, NC · General Practice Dentistry in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.