NPIMap

Organization Active NPI

Jason a. Stack, DMD, PA

  • Dental Clinic/Center
  • Greenville, SC
National Provider Identifier
1538183124
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3618 Issued in SC
Legal business name
JASON A. STACK, DMD, PA
Practice address
40 Creekview CT
Greenville, SC 29615-4800
Phone
(864) 676-0825
Fax
(864) 676-9859
NPI assigned
Jul 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jason Andrew Stack, DMDNPI 1063430510
Title
President
Phone
(864) 676-0825

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3618 SC Primary

Addresses

Primary practice location

40 Creekview CT
Greenville, SC 29615-4800

Mailing address

40 Creekview CT
Greenville, SC 29615-4800
Phone (864) 676-0825

National Provider Directory

National Provider Directory

Locations

40 Creekview Ct
Greenville, SC 29615
Phone (864) 676-0825

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538183124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CREEKVIEW CT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154800",
            "telephone_number": "864-676-0825",
            "fax_number": "864-676-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CREEKVIEW CT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154800",
            "telephone_number": "864-676-0825",
            "fax_number": "864-676-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON A. STACK, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-676-0825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "3618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.