Jacob Stadiem, D.M.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

30.025621 Issued in OH

Practice address

9380 Kenwood Rd
Blue Ash, OH 45242-6810

Phone

(513) 793-4470

NPI assigned

Oct 9, 2015

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

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": "1444348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1437520988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9380 KENWOOD RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426810",
            "telephone_number": "513-793-4770",
            "fax_number": "513-793-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9380 KENWOOD RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426810",
            "telephone_number": "513-793-4470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3284 Montgomery Rd",
            "address_purpose": "LOCATION",
            "city": "Loveland",
            "state": "OH",
            "postal_code": "451401071",
            "country_code": "US",
            "telephone_number": "513-793-4770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STADIEM",
        "first_name": "JACOB",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-09",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OH",
            "license": "30.025621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julianna Spinazze
• Michael E Spitz, MSW
• Laney Sportsman, STUDENT
• Roma Srivastava, M.D.
• SSC Therapeutic Services, LLC
• Sondra Stallworth
• Jeffrey C Standley, M.D.
• Eliza Stanford, OTR/L
• Kaitlyn A. Stanforth, LPCC
• Christopher Phillip Starks

• Orthodontics and Dentofacial Orthopedics Dentistry in Blue Ash, OH
• Providers in Blue Ash, OH by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.