NPIMap

Organization Active NPI

Stephen W. Hiatt DDS and Maryann L. Udy DMD PC

  • Oral and Maxillofacial Surgery (Dentist)
  • O'Fallon, MO
National Provider Identifier
1336314079
Registry record updated Jun 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
011813 Issued in MO
Legal business name
STEPHEN W. HIATT DDS AND MARYANN L. UDY DMD PC
Practice address
2992 Highway K
Ste 133
O Fallon, MO 63368-7861
Phone
(636) 978-6967
Fax
(636) 978-5905
NPI assigned
Apr 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2019

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

Authorized official

Name
Mrs. Lana S. Wisniewski
Title
Business Manager
Phone
(636) 978-6967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 011813 MO Primary

Addresses

Primary practice location

2992 Highway K
Ste 133
O Fallon, MO 63368-7861

Mailing address

5551 Winghaven Blvd. Ste. 210
O'Fallon, MO 63368
Phone (636) 978-6967

Other names 1

  • George T. Shuert DDS and Stephen W. Hiatt DDS PC Former legal business name

National Provider Directory

National Provider Directory

Locations

2992 Highway K
Ste 133
O Fallon, MO 63368
Phone (636) 978-6967

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561680000000",
    "number": "1336314079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5551 WINGHAVEN BLVD. STE. 210",
            "city": "O'FALLON",
            "state": "MO",
            "postal_code": "63368",
            "telephone_number": "636-978-6967",
            "fax_number": "636-978-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2992 HIGHWAY K",
            "address_2": "STE 133",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687861",
            "telephone_number": "636-978-6967",
            "fax_number": "636-978-5905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN W. HIATT DDS AND MARYANN L. UDY DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2019-06-28",
        "status": "A",
        "authorized_official_last_name": "WISNIEWSKI",
        "authorized_official_first_name": "LANA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "636-978-6967",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "011813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George T. Shuert DDS and Stephen W. Hiatt DDS PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in O'Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; 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.