Individual provider Active NPI

Spencer Sean Stcyr, D.D.S

  • General Practice Dentistry
  • Eldersburg, MD
National Provider Identifier
1427017003
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12837 Issued in MD
Practice address
6351 Oklahoma Rd
Eldersburg, MD 21784-6620
Phone
(410) 795-0101
Fax
(410) 795-0165
NPI assigned
Mar 21, 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 12837 MD Primary

Addresses

Primary practice location

6351 Oklahoma Rd
Eldersburg, MD 21784-6620

Mailing address

5973 Cecil Way
Eldersburg, MD 21784-8576
Phone (410) 795-0101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20191003000052 MD Order and Referring Only - DentistPractitioner - Dentist 0143472456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12837MDMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427017003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5973 CECIL WAY",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217848576",
            "telephone_number": "410-795-0101",
            "fax_number": "410-795-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6351 OKLAHOMA RD",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846620",
            "telephone_number": "410-795-0101",
            "fax_number": "410-795-0165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STCYR",
        "first_name": "SPENCER",
        "middle_name": "SEAN",
        "name_prefix": "Mr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, MD

Sources for this page

Verify at the official NPI Registry.