Individual provider Active NPI

Chad Michael Stoker, DDS

  • Dental Anesthesiology
  • Phoenix, AZ
National Provider Identifier
1629025259
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AnesthesiologyTaxonomy code 1223D0004X
License
D5354 Issued in AZ
Practice address
13601 N Canterbury Dr
Phoenix, AZ 85023-6290
Phone
(602) 459-7456
NPI assigned
May 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3093873-9924 UT
Dentist 122300000X 5354 AZ
Dental Anesthesiology 1223D0004X 11707 NC
Anesthesiology Physician 207L00000X 11707 NC
Dental Anesthesiology 1223D0004X D5354 AZ Primary

Addresses

Primary practice location

13601 N Canterbury Dr
Phoenix, AZ 85023-6290

Mailing address

625 W Southern Ave Ste E-145
Mesa, AZ 85210-5030

Other practice location 1

2643 Randleman Rd
Greensboro, NC 27406-5153
Phone (336) 544-2758

Other practice location 2

625 W Southern Ave Ste E-145
Mesa, AZ 85210-5030
Phone (480) 628-1556

Other identifiers 1

IdentifierTypeStateIssuer
571887MedicaidAZ

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

LicenseStateTypeSpecialty
5354AZMDDentist
3093873-9924UTMDDentist
D5354AZMDDentist Anesthesiologist
11707NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Comfort Care Anesthesia, LLC Dental Anesthesiology PastSince Sep 13, 2020 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.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1629025259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 W SOUTHERN AVE STE E-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13601 N CANTERBURY DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850236290",
            "telephone_number": "602-459-7456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2643 Randleman Rd",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274065153",
            "country_code": "US",
            "telephone_number": "336-544-2758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "625 W Southern Ave Ste E-145",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852105030",
            "country_code": "US",
            "telephone_number": "480-628-1556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOKER",
        "first_name": "CHAD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "3093873-9924",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "5354",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NC",
            "license": "11707",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "11707",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "AZ",
            "license": "D5354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "571887",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.