Eric Kapustka, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14426 Issued in MO

Practice address

125 Johnstown Dr
Rogersville, MO 65742-9366

Phone

(417) 753-2963

Fax

(417) 753-3543

NPI assigned

Oct 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417042102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 JOHNSTOWN DR",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657429366",
            "telephone_number": "417-753-2963",
            "fax_number": "417-753-3543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 JOHNSTOWN DR",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657429366",
            "telephone_number": "417-753-2963",
            "fax_number": "417-753-3543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPUSTKA",
        "first_name": "ERIC",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "14426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Catherine Howey
• Jamie Sheree Ipock, M.S, CCC-SLP
• Laura Jackson
• Janice L Jones, FNP
• John H Kaicher, M.D.
• Robert Joseph Kayser, D.C.
• Jennifer Leigh Kent, LCSW
• Dreama Jean Killingsworth, NP-C
• Kinetic Mobility LLC
• Tammy Jo Knight, DPT

• General Practice Dentistry in Rogersville, MO
• Providers in Rogersville, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.