Active NPI
Tera Staffon
- Dental Hygienist
- Beloit, WI
National Provider Identifier
1639720980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 10345-16
- Practice address
- 74 Eclipse Ctr
Beloit, WI 53511-3550 - Phone
- (608) 361-0311
- NPI assigned
- Sep 26, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 10345-16 | WI | Primary |
Addresses
Primary practice location
74 Eclipse Ctr
Beloit, WI 53511-3550
Mailing address
74 Eclipse Ctr
Beloit, WI 53511-3550
Phone (608) 361-0311
Other names 1
- Tera Gilbertson
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 |
|---|---|---|---|
| 10345-16 | WI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569456000000",
"number": "1639720980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74 ECLIPSE CTR",
"city": "BELOIT",
"state": "WI",
"postal_code": "535113550",
"telephone_number": "608-361-0311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 ECLIPSE CTR",
"city": "BELOIT",
"state": "WI",
"postal_code": "535113550",
"telephone_number": "608-361-0311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFON",
"first_name": "TERA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-26",
"last_updated": "2019-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "10345-16",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TERA",
"last_name": "GILBERTSON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Beloit, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.