NPIMap

Organization Active NPI

Southwest Orthodontic Associates, PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Council Bluffs, IA
National Provider Identifier
1306003520
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
06149 Issued in IA
Legal business name
SOUTHWEST ORTHODONTIC ASSOCIATES, PC
Practice address
40 Northcrest Dr Ste 2
Council Bluffs, IA 51503-1698
Phone
(712) 323-7589
Fax
(712) 323-8255
NPI assigned
May 16, 2008
Last updated
May 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Authorized official

Name
Dr. Wendell R. Stuntz, D.D.S.NPI 1508943986
Title
Owner
Phone
(712) 323-7589

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 06149 IA Primary

Addresses

Primary practice location

40 Northcrest Dr Ste 2
Council Bluffs, IA 51503-1698

Mailing address

40 Northcrest Dr Ste 2
Council Bluffs, IA 51503-1698
Phone (712) 323-7589

Other identifiers 2

IdentifierTypeStateIssuer
1689868945MedicaidIA
1508943986MedicaidIA

National Provider Directory

National Provider Directory

Locations

40 Northcrest Dr
Ste 2
Council Bluffs, IA 51503
Phone (712) 323-7589

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1306003520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 NORTHCREST DR STE 2",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031698",
            "telephone_number": "712-323-7589",
            "fax_number": "712-323-8255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 NORTHCREST DR STE 2",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031698",
            "telephone_number": "712-323-7589",
            "fax_number": "712-323-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST ORTHODONTIC ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "STUNTZ",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-323-7589",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IA",
            "license": "06149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689868945",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508943986",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.