Amanda Paige Stater, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

10401 Issued in SC

Practice address

1015 N Main St
Summerville, SC 29483-6706

Phone

(843) 486-3144

NPI assigned

May 2, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Amanda Paige Crummett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1386389690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8344 BENT OAK DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462366369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 N MAIN ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836706",
            "telephone_number": "843-486-3144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4758 S Scatterfield Rd",
            "address_purpose": "LOCATION",
            "city": "Anderson",
            "state": "IN",
            "postal_code": "460132908",
            "country_code": "US",
            "telephone_number": "765-642-9500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STATER",
        "first_name": "AMANDA",
        "middle_name": "PAIGE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-02",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "10401",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013783A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "CRUMMETT",
            "middle_name": "PAIGE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Star, LLC
• Kelly Marie Starbuck, LPC
• Tyler John Starkweather, DPT
• Serena Stasko
• State of South Carolina
• Jack Allan Stauffer, FNP
• Richard Anderson Steadman III, M.D.
• Avery Lauren Steeland
• Christopher Thomas Steeley, DMD
• Stephen

• Dentist in Summerville, SC
• Providers in Summerville, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.

Verify at the official NPI Registry.