Stacy Marie Shearen, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12393 Issued in MN

Practice address

2418 Enterprise Dr
Suite B
Mendota Heights, MN 55120-1362

Phone

(651) 452-2116

NPI assigned

Jun 29, 2007

Sex

Female

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 MN

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Enterprise Dental, Inc.

  • General Practice Dentistry
  • Mendota Heights, MN
  • NPI 1447422175
  NPD (past)
• Ghassemlouei and Gunderson Dental Practice PLLC

  • General Practice Dentistry
  • Mendota Heights, MN
  • NPI 1598449688
  NPD (past)

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316144603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 E PLEASANT LAKE RD",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551276316",
            "telephone_number": "651-238-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 ENTERPRISE DR",
            "address_2": "SUITE B",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201362",
            "telephone_number": "651-452-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEAREN",
        "first_name": "STACY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Sebring, DPT
• Robert Henry Seeds, P.T. PHD
• Carlie Pearl Seip
• Sengistix, LLC
• Sexual Wellness Institute
• Teddy Sherva
• Zarlasht Shinwari
• Endashawe Gebre Shishige
• Alexis Sievert
• Clarissa Abigail Sigale

• General Practice Dentistry in Mendota Heights, MN
• Providers in Mendota Heights, MN by specialty
• General Practice Dentistry in Minnesota

• 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.