Chad G. Stutsman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010385 Issued in IN

Practice address

1801 Charlton CT
Goshen, IN 46526-6464

Phone

(574) 533-8934

Fax

(574) 533-9487

NPI assigned

May 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Goshen Cosmetic and Advanced Family Dentistry PC

  • General Practice Dentistry
  • Goshen, IN
  • NPI 1356562631
  NPD (past) Authorized official

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710108030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 CHARLTON CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266464",
            "telephone_number": "574-533-8934",
            "fax_number": "574-533-9487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CHARLTON CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266464",
            "telephone_number": "574-533-8934",
            "fax_number": "574-533-9487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUTSMAN",
        "first_name": "CHAD",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Joybirkholz Stone, M.D.
• Lindsey N Stose, MSW, LSW
• Kimberly Sue Stuckey Schrock, M.D.
• Teneesa Stuckey, WHNP
• Stacia Stults
• Gene A. Stutsman, DDS
• Phyllis D Stutzman, MSW
• Michelle Suen, RN, MSN, PMHNP
• Mayra Suter, LCSW
• Sharese A. Swafford, LMHC, LCAC

• General Practice Dentistry in Goshen, IN
• Providers in Goshen, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.