Active NPI
Jennifer Stevenson, D.D.S.
- Dentist
- Waverly, IA
National Provider Identifier
1760672109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 08511
- Practice address
- 203 20TH St NW
Waverly, IA 50677-2017 - Phone
- (319) 352-5222
- NPI assigned
- Aug 1, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 08511 | IA | Primary |
Addresses
Primary practice location
203 20TH St NW
Waverly, IA 50677-2017
Mailing address
203 20TH St NW
Waverly, IA 50677-2017
Phone (319) 352-5222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0076372 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08511 | IA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215388800000",
"number": "1760672109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 20TH ST NW",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506772017",
"telephone_number": "319-352-5222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 20TH ST NW",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506772017",
"telephone_number": "319-352-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "JENNIFER",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-01",
"last_updated": "2008-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "08511",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0076372",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waverly, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.