Active NPI
David J Stoneburner, DMD
- Dentist
- Hibbing, MN
National Provider Identifier
1558737676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019030386
- Practice address
- 2005 8TH Ave E
Hibbing, MN 55746-1707 - Phone
- (218) 263-8348
- NPI assigned
- Aug 12, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019030386 | IL | Primary |
Addresses
Primary practice location
2005 8TH Ave E
Hibbing, MN 55746-1707
Mailing address
10590 Enduring Freedom Dr
Fort Drum, NY 13602-5005
Phone (315) 772-6234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 25, 2021 through Jun 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030386 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555545600000",
"number": "1558737676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10590 ENDURING FREEDOM DR",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025005",
"telephone_number": "315-772-6234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 8TH AVE E",
"city": "HIBBING",
"state": "MN",
"postal_code": "557461707",
"telephone_number": "218-263-8348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STONEBURNER",
"first_name": "DAVID",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-12",
"last_updated": "2019-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019030386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hibbing, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.