Active NPI
Stephanie Henricks, D.M.D.
- Dentist
- Quincy, IL
National Provider Identifier
1356743082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.029956
- Practice address
- 331 S 36TH St Ste 1
Quincy, IL 62301-5840 - Phone
- (217) 223-9137
- NPI assigned
- Sep 25, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.029956 | IL | Primary |
Addresses
Primary practice location
331 S 36TH St Ste 1
Quincy, IL 62301-5840
Mailing address
331 S 36TH St Ste 1
Quincy, IL 62301-5840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150609002135 | IL | Order and Referring Only - Other (Non-Physician) | 7113248691 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029956 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434412800000",
"number": "1356743082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "331 S 36TH ST STE 1",
"city": "QUINCY",
"state": "IL",
"postal_code": "623015840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 S 36TH ST STE 1",
"city": "QUINCY",
"state": "IL",
"postal_code": "623015840",
"telephone_number": "217-223-9137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRICKS",
"first_name": "STEPHANIE",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-25",
"last_updated": "2015-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.029956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; 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.