Russell John Stephens, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60851015 Issued in WA

Practice address

424 N. Warren Ave.
Newport, WA 99156

Phone

(509) 447-5960

Fax

(575) 572-2259

NPI assigned

Oct 1, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Russell Stephens Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Ivory Dental PLLC

  • General Practice Dentistry
  • Newport, WA
  • NPI 1275027591
  NPD (past)
• Wayne Lemley DDS

  • General Practice Dentistry
  • Newport, WA
  • NPI 1457808784
  NPD (past)

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1558764845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 N. WARREN AVE.",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "99156",
            "telephone_number": "509-447-5960",
            "fax_number": "575-572-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 N. WARREN AVE.",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "99156",
            "telephone_number": "509-447-5960",
            "fax_number": "575-572-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "RUSSELL",
        "middle_name": "JOHN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-01",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "9051997-9921",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60851015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RUSSELL",
            "last_name": "STEPHENS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gregory Charles Seeber, RPH
• Carissa Shaw
• Mary Sue Siemsen, M.S.
• Rustymae Squires
• Brittany L Stemarie
• Tonya M Stern
• Madison Lily Stewart, LICSW
• Taylor Katherine Stewart, MD
• Jennifer Stout-Willett, LICSW
• Angela Strange

• General Practice Dentistry in Newport, WA
• Providers in Newport, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.