NPIMap

Organization Active NPI

M Shane Stevenson DMD, MD Oral and Maxillofacial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Decatur, AL
National Provider Identifier
1700975554
Registry record updated Oct 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
5063 Issued in AL
Legal business name
M SHANE STEVENSON DMD, MD ORAL AND MAXILLOFACIAL SURGERY, PC
Practice address
1401 Stratford Rd SE
Decatur, AL 35601-6022
Phone
(256) 355-1242
Fax
(256) 355-1259
NPI assigned
Oct 12, 2006
Last updated
Oct 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2008

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

Authorized official

Name
Dr. Michael Shane Stevenson, DMD, MDNPI 1700822020
Title
President
Phone
(256) 355-1242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 5063 AL Primary

Addresses

Primary practice location

1401 Stratford Rd SE
Decatur, AL 35601-6022

Mailing address

1401 Stratford Rd SE
Decatur, AL 35601-6022
Phone (256) 355-1242

National Provider Directory

National Provider Directory

Locations

1401 Stratford Rd SE
Decatur, AL 35601
Phone (256) 355-1242

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225324800000",
    "number": "1700975554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 STRATFORD RD SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356016022",
            "telephone_number": "256-355-1242",
            "fax_number": "256-355-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 STRATFORD RD SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356016022",
            "telephone_number": "256-355-1242",
            "fax_number": "256-355-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M SHANE STEVENSON DMD, MD ORAL AND MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2008-10-30",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-355-1242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD,  MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "5063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2008; 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.