Jack Herbert Stansfield, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

24346 Issued in CA

Practice address

10425 Fair Oaks Blvd
Suite #204
Fair Oaks, CA 95628-7559

Phone

(916) 962-2244

Fax

(916) 962-2750

NPI assigned

May 20, 2008

Sex

Male

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 CA

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

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1346407194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10425 FAIR OAKS BLVD",
            "address_2": "SUITE 204",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "95608",
            "telephone_number": "916-962-2244",
            "fax_number": "916-962-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10425 FAIR OAKS BLVD",
            "address_2": "SUITE #204",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956287559",
            "telephone_number": "916-962-2244",
            "fax_number": "916-962-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANSFIELD",
        "first_name": "JACK",
        "middle_name": "HERBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "24346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Fair Oaks, CA
• Providers in Fair Oaks, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.