Sandra Crum-Stevens, DMD
Individual provider Active NPI Dentist · Clay City, KY
NPI 1487793113 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1487793113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- KY6977 (KY)
- Practice address
- 98 River Street Suite a
Clay City, KY 40312 - Phone
- (606) 663-5473
- Fax
- (606) 663-0106
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170203000969 | KY | Practitioner - Oral Surgery | 6305129040 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY6977 | KY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Special Care Dental of Kentucky PLLC | Current |
Accepting new patients |
Locations
106 Padgett Dr
Clinton, KY 42031
Phone (270) 653-5558
12910 Shelbyville Rd
Ste 300
Louisville, KY 40243
Phone (502) 214-0693
Interoperability endpoints
- sandra.crumstevens.p1@direct.360care.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | KY6977 | KY | Yes |
Addresses
Primary practice location
98 River Street Suite a
Clay City, KY 40312
Mailing address
98 River Street Suite a
P.O. Box 607
Clay City, KY 40312
Phone (606) 663-5473
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60069770 | Medicaid | KY |
Other providers in Clay City, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.