Gordon D. Stabley, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D011616 Issued in AZ

Practice address

530 E McDowell Rd
Phoenix, AZ 85004-1549

Phone

(602) 281-9540

NPI assigned

May 24, 2011

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

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1497048557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 ROMA DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711053616",
            "telephone_number": "262-716-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041549",
            "telephone_number": "602-281-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STABLEY",
        "first_name": "GORDON",
        "middle_name": "D.",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-24",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D011616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Charles St.James, D.P.T
• Robert Nicholas Staab, MD
• Sasha O'Brien Staack, MD
• Sara Poletti Stabenow, OTR/L
• Seth Alan Stabinsky, M.D.
• Stacey D McClure MD PLLC
• Stacey Krueger Therapy LLC
• Martha Stacey II
• J Bruce Stadwiser, M.D.
• Jordan Nicole Staenberg, OTD, OTR/L

• Oral and Maxillofacial Surgery (Dentist) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.

Verify at the official NPI Registry.