Individual provider Active NPI

Steven B Andreaus, DDS

  • General Practice Dentistry
  • Raleigh, NC
National Provider Identifier
1396768602
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
200001390045 Issued in NC
Practice address
1637 Glenwood Ave
Raleigh, NC 27608-2319
Phone
(919) 546-9011
Fax
(919) 546-9014
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 200001390045 NC Primary

Addresses

Primary practice location

1637 Glenwood Ave
Raleigh, NC 27608-2319

Mailing address

1637 Glenwood Ave
Raleigh, NC 27608-2319
Phone (919) 546-9011

Other identifiers 1

IdentifierTypeStateIssuer
200001390045OtherNCPRIVILEGE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150723007232 NC Order and Referring Only - DentistPractitioner - Dentist 0446563159

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5765NCMDPsychologist
200001390045NCMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396768602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1637 GLENWOOD AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276082319",
            "telephone_number": "919-546-9011",
            "fax_number": "919-546-9014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1637 GLENWOOD AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276082319",
            "telephone_number": "919-546-9011",
            "fax_number": "919-546-9014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDREAUS",
        "first_name": "STEVEN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "200001390045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVILEGE LICENSE",
            "identifier": "200001390045",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.