Active NPI
Susan I Stover, DDS
- General Practice Dentistry
- Gastonia, NC
National Provider Identifier
1689617029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5110
- Practice address
- 1367 E Garrison Blvd
Ste a
Gastonia, NC 28054-5144 - Phone
- (704) 864-8393
- Fax
- (704) 864-7312
- NPI assigned
- Jun 14, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5110 | NC | Primary |
Addresses
Primary practice location
1367 E Garrison Blvd
Ste a
Gastonia, NC 28054-5144
Mailing address
1367 E Garrison Blvd
Ste a
Gastonia, NC 28054-5144
Phone (704) 864-8393
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 561528161016 | Other | WI | BCBS OF WI |
| 02929 | Other | NC | BCBS OF NC |
| 8998146 | Medicaid | NC | |
| 465958 | Other | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20200630000219 | NC | Order and Referring Only - Dentist | 1355662362 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5110 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1689617029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1367 E GARRISON BLVD",
"address_2": "STE A",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280545144",
"telephone_number": "704-864-8393",
"fax_number": "704-864-7312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1367 E GARRISON BLVD",
"address_2": "STE A",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280545144",
"telephone_number": "704-864-8393",
"fax_number": "704-864-7312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOVER",
"first_name": "SUSAN",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "5110",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF WI",
"identifier": "561528161016",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "02929",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8998146",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "465958",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.