Stephen A Rendulich, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7749 Issued in NC

Practice address

9713 Northcross Center CT Ste 100
Huntersville, NC 28078-7352

Phone

(704) 875-8833

Fax

(704) 875-0303

NPI assigned

Sep 16, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 19, 2018 through Jan 19, 2028

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.

• Oral and Maxillofacial Surgery, LTD.

  • Oral and Maxillofacial Surgery (Dentist)
  • Greensburg, PA
  • NPI 1629020771
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1356447031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9713 NORTHCROSS CENTER CT STE 100",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787352",
            "telephone_number": "704-875-8833",
            "fax_number": "704-875-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9713 NORTHCROSS CENTER CT STE 100",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787352",
            "telephone_number": "704-875-8833",
            "fax_number": "704-875-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENDULICH",
        "first_name": "STEPHEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "7749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Antoinette Reid, MD
• Tanya Reid, LPN
• Kristina Reihl, PH.D.
• Reimagine Billing Concepts LLC
• Michael Owen Reimels, DDS
• Renewed Hope Counseling Center
• Michelle Sui Renninger, CRNA
• Alesha Lamm Respess, CNM
• Return 2 Play LLC
• Todd R Reulbach, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.