Stephen M Vicalvi DDS

Primary specialty

DentistTaxonomy code 122300000X

License

00007603 Issued in CO

Legal business name

STEPHEN M VICALVI DDS

Practice address

1100 E Main St
Ste D
Montrose, CO 81401-4064

Phone

(970) 240-2720

Fax

(970) 240-2724

NPI assigned

Sep 1, 2015

Organization subpart

No

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

Authorized official

Name

Stephen M Jvicalvi, DDS

Title

Owner

Phone

(970) 901-9822

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1811364284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E MAIN ST",
            "address_2": "STE D",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814014064",
            "telephone_number": "970-240-2720",
            "fax_number": "970-240-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MAIN ST",
            "address_2": "STE D",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814014064",
            "telephone_number": "970-240-2720",
            "fax_number": "970-240-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN M VICALVI DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "JVICALVI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-901-9822",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "00007603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99756340",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Montrose, CO
• Providers in Montrose, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.