Active NPI
Stephen Todd Phelan, D.D.S.
- General Practice Dentistry
- Rogers, AR
National Provider Identifier
1508924903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3489
- Practice address
- 2102 W Pleasant Grove Rd
Suite 1
Rogers, AR 72758-8242 - Phone
- (479) 636-3400
- NPI assigned
- Dec 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3489 | AR | Primary |
Addresses
Primary practice location
2102 W Pleasant Grove Rd
Suite 1
Rogers, AR 72758-8242
Mailing address
2102 W Pleasant Grove Rd
Suite 1
Rogers, AR 72758-8242
Phone (479) 636-3400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5Y261 | Other | AR | BCBS NUMBER |
| 163953608 | Medicaid | AR |
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 |
|---|---|---|---|
| 3489 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| S Todd Phelan, DDS, PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Rogers, AR
- NPI 1508054214
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210032000000",
"number": "1508924903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2102 W PLEASANT GROVE RD",
"address_2": "SUITE 1",
"city": "ROGERS",
"state": "AR",
"postal_code": "727588242",
"telephone_number": "479-636-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2102 W PLEASANT GROVE RD",
"address_2": "SUITE 1",
"city": "ROGERS",
"state": "AR",
"postal_code": "727588242",
"telephone_number": "479-636-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "STEPHEN",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2008-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "3489",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "5Y261",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "163953608",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.