Daniel John Stackowicz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5162 Issued in ID

Practice address

1410 S Entertainment Ave
Boise, ID 83709-8306

Phone

(208) 321-4937

Fax

(208) 321-4834

NPI assigned

Feb 21, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Affordable Dentures & Implants - Idaho II, PLLC

  • General Practice Dentistry
  • Boise, ID
  • NPI 1043060494
  NPD
• Anne K. Steinberg, DMD, P. C.

  • Dentist
  • Boise, ID
  • NPI 1396183976
  NPD (past)

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

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1740605104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 S ENTERTAINMENT AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837098306",
            "telephone_number": "208-321-4937",
            "fax_number": "208-321-4834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 S ENTERTAINMENT AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837098306",
            "telephone_number": "208-321-4937",
            "fax_number": "208-321-4834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7500 Cambridge St",
            "address_2": "Suite 6510",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770542032",
            "country_code": "US",
            "telephone_number": "713-586-4052",
            "fax_number": "713-486-4333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACKOWICZ",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-21",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D5162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Jean Stace, LMSW
• Julie Lynn Stace, CSFA
• Stacey Titus PLLC
• Eric Gerand Stackle, MD
• Mary J Stackle, NP
• Stacy J. Moon DDS, PA
• Mardi Stacy, PH.D.
• Stephanie Elizabeth Stacy
• Heather Ann Stafford, NP-C
• Kayla Stafford

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; 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.