Steven Edward Smullin, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10246 Issued in CT

Practice address

10 South St Ste 202
Ridgefield, CT 06877-4125

Phone

(203) 403-3686

NPI assigned

Nov 8, 2005

Last updated

Mar 14, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 2, 2013 through Oct 2, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ridgefield Oral and Maxillofacial Surgery, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Ridgefield, CT
  • NPI 1083173538
  NPD (past) Authorized official
• Lahey Clinic, Inc

  • Internal Medicine Physician
  • Peabody, MA
  • NPI 1063447316
  NPD (past)

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1679554513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 BROOKHOLLOW LN",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069021014",
            "telephone_number": "617-230-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SOUTH ST STE 202",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "068774125",
            "telephone_number": "203-403-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMULLIN",
        "first_name": "STEVEN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "10246",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "20571",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MA",
            "license": "231511",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110076671A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Skennion, LPCA
• Skillful Psychiatry, P.C.
• Alanna M Smith, PA-C
• Rebecca Smith
• Daniel J Smuckler, MD
• Lucille Soldano, M.D.
• Stephanie Sousa Cardoso, ND
• Katelynn Alysse Spann, MS, OTR/L
• Daniel B Spencer, M.D.
• Margaret Spera, APRN

• Oral and Maxillofacial Surgery (Dentist) in Ridgefield, CT
• Providers in Ridgefield, CT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.