Jennifer M Stafford, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6256 Issued in WI

Practice address

201 Sherman Ave West
Fort Atkinson, WI 53538

Phone

(920) 563-7323

Fax

(920) 563-7612

NPI assigned

Jul 11, 2008

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 WI

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

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.

• 201 Water Front Dental LLC

  • General Practice Dentistry
  • Fort Atkinson, WI
  • NPI 1902912165
  NPD

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1811151574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SHERMAN AVE WEST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "53538",
            "telephone_number": "920-563-7323",
            "fax_number": "920-563-7612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SHERMAN AVE WEST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "53538",
            "telephone_number": "920-563-7323",
            "fax_number": "920-563-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichole Lynn Smith, REGISTERED NURSE
• Samuel C Smith, PHD
• Nathan Spangler, CRNA
• Jenna N Specchio, SLP
• Sport & Spine Clinic of Fort Atkinson Limited Partnership
• Rebecca Lynn Stark-Johnson, CRNA
• Patricia A Steckelmann, P.A.
• Steven Strasser
• Lauren Streets, PHARMD
• Kathleen Kay Strucley, PT

• General Practice Dentistry in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; 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.