NPIMap

Organization Active NPI

Stater Dental

  • Dentist
  • Centerville, IA
National Provider Identifier
1720478878
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DDS-06366 Issued in IA
Legal business name
STATER DENTAL
Practice address
112 N 10TH St
Centerville, IA 52544-1730
Phone
(641) 856-8643
NPI assigned
Jan 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Authorized official

Name
Dr. Craig Douglas Stater, DMD
Title
Dentist
Phone
(641) 856-8643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DDS-06366 IA Primary

Addresses

Primary practice location

112 N 10TH St
Centerville, IA 52544-1730

Mailing address

112 N 10TH St
Centerville, IA 52544-1730
Phone (641) 856-8643

Other identifiers 1

IdentifierTypeStateIssuer
1821160755MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Community Care Services456 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 4

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

112 N 10th St
Centerville, IA 52544
Phone (641) 856-8643

NPI Registry JSON

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1720478878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N 10TH ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525441730",
            "telephone_number": "641-856-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N 10TH ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525441730",
            "telephone_number": "641-856-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "STATER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "641-856-8643",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-06366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821160755",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; 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.