Active NPI
Symon Benjamin Stanley, DDS
- General Practice Dentistry
- Breckenridge, CO
National Provider Identifier
1356636229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 27047
- Practice address
- 235 S Ridge Street Ste 2B
Breckenridge, CO 80424 - Phone
- (970) 453-4244
- NPI assigned
- Jun 18, 2011
- Last updated
- Sep 23, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 00201947 | CO | |
| General Practice Dentistry | 1223G0001X | 27047 | TX | Primary |
Addresses
Primary practice location
235 S Ridge Street Ste 2B
Breckenridge, CO 80424
Mailing address
PO Box 1817
Breckenridge, CO 80424
Phone (970) 453-4244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170111000255 | CO | Order and Referring Only - Other (Physician) | 4688955388 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00201947 | CO | MD | Dentist |
| 27047 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Three Lines PLLC | Current | Accepting new patients | |
| Fort Collins Modern Dentistry, LLP | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Fort Collins Modern Dentistry
- General Practice Dentistry
- Fort Collins, CO
- NPI 1013224062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1356636229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1817",
"city": "BRECKENRIDGE",
"state": "CO",
"postal_code": "80424",
"telephone_number": "970-453-4244",
"fax_number": "970-360-2683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 S RIDGE STREET STE 2B",
"city": "BRECKENRIDGE",
"state": "CO",
"postal_code": "80424",
"telephone_number": "970-453-4244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "SYMON",
"middle_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-18",
"last_updated": "2022-09-23",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "00201947",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "27047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Breckenridge, CO
- Michelle M Searles, C.N.
- Rebeca Y. Sipe, R.M.T.
- Stacy Smith, LPC
- Morgan E Sneller, DPT
- Colin John Snyder, PT DPT
- Kay Sterling, MS,PT
- Jill Annette Strandquist, OTR
- Summit Allied Behavioral Services, LLC
- Summit Community Care Clinic, Inc. (Elevated Community Health)
- Summit Community Care Clinic, Inc. (Elevated Community Health)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.