Jennifer Decota, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2000158416 Issued in MO

Practice address

1391 Smizer Mill Rd
Suite 104
Fenton, MO 63026-7306

Phone

(636) 349-2400

NPI assigned

May 3, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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 MO

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

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780806109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 SMIZER MILL RD",
            "address_2": "SUITE 104",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267306",
            "telephone_number": "636-349-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1391 SMIZER MILL RD",
            "address_2": "SUITE 104",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267306",
            "telephone_number": "636-349-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECOTA",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2000158416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davis, Wright, Berdy & Suffian PC (Allergy Consultants)
• Dawn McFarland PSYD LLC
• Day Optometry, Inc. (Fenton Family Eyecare)
• Deco Dental
• Adam Decota, D.D.S.
• Kelly L Degeare, MSW, LCSW
• Delmar Gardens of Meramec Valley Operating, LLC (Delmar Gardens of Meramec Valley)
• Delta Health
• Anne Demerit
• Stacie D Detmer, FNP

• General Practice Dentistry in Fenton, MO
• Providers in Fenton, MO by specialty
• General Practice Dentistry in Missouri

• 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.