Korey B Still, DDS
Individual provider Active NPI Dentist · Acoma, NM
NPI 1356850754 · NPPES record last updated Nov 6, 2017
Key facts
- NPI
- 1356850754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2017029561 (MO)
- Practice address
- 80 B Veterans Blvd.
Acoma, NM 87034 - Phone
- (505) 552-5300
- NPI assigned
- Sep 28, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190429001096 | NM | Order and Referring Only - Dentist |
7810239563 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017029561 | MO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2017029561 | MO | Yes |
Addresses
Primary practice location
80 B Veterans Blvd.
Acoma, NM 87034
Mailing address
PO Box 130
San Fidel, NM 87049-0130
Phone (505) 552-5300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H3451 | Medicaid | NM |
Other providers in Acoma, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.