State Fair Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STATE FAIR DENTAL LLC

Doing business as

Hometown Dental

Practice address

1806 W 5TH St
Sedalia, MO 65301-2420

Phone

(972) 869-3789

NPI assigned

Dec 10, 2020

Last updated

Dec 10, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Faith Gaskins

Title

Director of Credentialing

Phone

(630) 877-3520

Specialties & licenses 1

Addresses

Other names 1

• Hometown Dental Doing business as

Locations

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

{
    "created_epoch": "1607558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1326644600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 W 5TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012420",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 W 5TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012420",
            "telephone_number": "972-869-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE FAIR DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-10",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "630-877-3520"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina Nicole Spears, APRN
• Jamie Spears, MD
• Gerald W Spencer, DDS
• Springhealth Behavioral Health and Integrated Care Missouri, LLC
• Stacy Jeffries (Jeffries ISL MW)
• Morgan Steck
• Joseph Lyle Stegman, MD
• Emily Stenger, LMSW
• Stephanie Sutherland Pmhnp-BC, Inc.
• Logan Scott Stiens, MD

• General Practice Dentistry in Sedalia, MO
• Providers in Sedalia, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.