Active NPI
Stephen Vance Moorkamp, DDS
- General Practice Dentistry
- Rolla, MO
National Provider Identifier
1649769860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2017017371
- Practice address
- 912 N Cedar St
Rolla, MO 65401-3350 - Phone
- (573) 364-1345
- NPI assigned
- May 2, 2018
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2017017371 | MO | Primary |
Addresses
Primary practice location
912 N Cedar St
Rolla, MO 65401-3350
Mailing address
902 Country LN
Rolla, MO 65401-4716
Phone (573) 578-6623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200812000900 | MO | Order and Referring Only - Dentist | 6103242193 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017017371 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525219200000",
"number": "1649769860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 COUNTRY LN",
"city": "ROLLA",
"state": "MO",
"postal_code": "654014716",
"telephone_number": "573-578-6623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 N CEDAR ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013350",
"telephone_number": "573-364-1345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORKAMP",
"first_name": "STEPHEN",
"middle_name": "VANCE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-02",
"last_updated": "2018-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2017017371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.