Active NPI
Stephanie Necole Wakefield, DDS
- General Practice Dentistry
- Dallas, TX
National Provider Identifier
1356034060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 39485
- Practice address
- 4396 I30 Ste 110
Dallas, TX 75211-1351 - Phone
- (214) 451-2424
- NPI assigned
- May 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | CO | ||
| General Practice Dentistry | 1223G0001X | 39485 | TX | Primary |
Addresses
Primary practice location
4396 I30 Ste 110
Dallas, TX 75211-1351
Mailing address
1309 Sandalwood Rd
Royse City, TX 75189-8166
Phone (214) 714-2265
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P915762 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39485 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686873600000",
"number": "1356034060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1309 SANDALWOOD RD",
"city": "ROYSE CITY",
"state": "TX",
"postal_code": "751898166",
"telephone_number": "214-714-2265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4396 I30 STE 110",
"city": "DALLAS",
"state": "TX",
"postal_code": "752111351",
"telephone_number": "214-451-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKEFIELD",
"first_name": "STEPHANIE",
"middle_name": "NECOLE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-30",
"last_updated": "2023-06-16",
"certification_date": "2023-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CO",
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "39485",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P915762",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.