Active NPI
Stephanie Elaine Bont, DMD
- Pediatric Dentistry
- Quincy, MA
National Provider Identifier
1457003790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN1859949
- Practice address
- 300 Crown Colony Dr Ste 203
Quincy, MA 02169 - Phone
- (617) 472-2580
- NPI assigned
- Jan 18, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | DN1859949 | MA | Primary |
| Pediatric Dentistry | 1223P0221X | 10318 | SC |
Addresses
Primary practice location
300 Crown Colony Dr Ste 203
Quincy, MA 02169
Mailing address
60 Elliot Ave
Quincy, MA 02171-2609
Other practice location 1
158 Waccamaw Medical Park Ct
Conway, SC 29526-8965
Phone (843) 428-2469
Other practice location 2
13123 E 16th Ave
Aurora, CO 80045-7106
Phone (720) 777-4044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859949 | MA | MD | Pediatric Dentist |
| 10318 | SC | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709683200000",
"number": "1457003790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 ELLIOT AVE",
"city": "QUINCY",
"state": "MA",
"postal_code": "021712609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 CROWN COLONY DR STE 203",
"city": "QUINCY",
"state": "MA",
"postal_code": "02169",
"telephone_number": "617-472-2580"
}
],
"practiceLocations": [
{
"address_1": "158 Waccamaw Medical Park Ct",
"address_purpose": "LOCATION",
"city": "Conway",
"state": "SC",
"postal_code": "295268965",
"country_code": "US",
"telephone_number": "843-428-2469",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "13123 E 16th Ave",
"address_purpose": "LOCATION",
"city": "Aurora",
"state": "CO",
"postal_code": "800457106",
"country_code": "US",
"telephone_number": "720-777-4044",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BONT",
"first_name": "STEPHANIE",
"middle_name": "ELAINE",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-18",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DN1859949",
"primary": true
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "SC",
"license": "10318",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quincy, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.