Active NPI
Stephen J Wachendorf, DDS
- General Practice Dentistry
- Cincinnati, OH
National Provider Identifier
1417095217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 18299
- Practice address
- 6059 Bridgetown Rd
Cincinnati, OH 45248 - Phone
- (513) 598-6700
- Fax
- (513) 598-5132
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18299 | OH | Primary |
Addresses
Primary practice location
6059 Bridgetown Rd
Cincinnati, OH 45248
Mailing address
6059 Bridgetown Rd
Cincinnati, OH 45248
Phone (513) 598-6700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150410002489 | OH | Order and Referring Only - Oral Surgery | 5698093219 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18299 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417095217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6059 BRIDGETOWN RD",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "45248",
"telephone_number": "513-598-6700",
"fax_number": "513-598-5132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6059 BRIDGETOWN RD",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "45248",
"telephone_number": "513-598-6700",
"fax_number": "513-598-5132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACHENDORF",
"first_name": "STEPHEN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "18299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- 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.