Active NPI
Coury Staadecker, D.D.S., M.S.
- Periodontics
- Irvine, CA
National Provider Identifier
1932258332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 48025
- Practice address
- 405 Rockefeller
504
Irvine, CA 92612-7188 - Phone
- (619) 665-2705
- NPI assigned
- Jan 9, 2007
- Last updated
- May 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 48025 | CA | Primary |
Addresses
Primary practice location
405 Rockefeller
504
Irvine, CA 92612-7188
Mailing address
1441 Avocado Ave
405
Newport Beach, CA 92660-7721
Phone (949) 640-9475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140424001443 | CA | Order and Referring Only - Oral Surgery | 2365675543 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48025 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337212800000",
"number": "1932258332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1441 AVOCADO AVE",
"address_2": "405",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926607721",
"telephone_number": "949-640-9475",
"fax_number": "949-640-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 ROCKEFELLER",
"address_2": "504",
"city": "IRVINE",
"state": "CA",
"postal_code": "926127188",
"telephone_number": "619-665-2705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAADECKER",
"first_name": "COURY",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2012-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "48025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
- St. Jude Hospital Yorba Linda (Masimo Wellness Center)
- St. Jude Hospital Yorba Linda (Wellness-Jamboree Center)
- St. Jude Hospital Yorba Linda (DRIVE Wellness Center)
- St. Jude Hospital Yorba Linda (Wellness-Village)
- St. Jude Hospital Yorba Linda (Wellness-Park Place)
- Ashley Eve Stading
- Rodd E. Stafford, D.C.
- Stan Chien, D.D.S.
- Edward Paul Stanley, R.N.
- Gayanne Stanley
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; 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.