Thomas E Stakem, D.D.S.,M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN16222 Issued in FL

Practice address

7175-01 U.S. Highway 17 South
Green Cove Springs, FL 32095

Phone

(904) 529-8889

Fax

(904) 529-8893

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932259405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 SOPHIA TER",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320956839",
            "telephone_number": "904-529-8889",
            "fax_number": "904-529-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7175-01 U.S. HIGHWAY 17 SOUTH",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "32095",
            "telephone_number": "904-529-8889",
            "fax_number": "904-529-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAKEM",
        "first_name": "THOMAS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN16222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smiling Creations, PA
• Kayla Smith, FNP-BC
• Lawrence Matthew Smith, PHARMD
• Qiana Smith
• Hannah Souksavong, PT, DPT
• Stephen B. Gill, M.D.,P.a.
• Hannah Mae Lynn Steward, RBT
• Kristina Stewart, M.A.
• April Rae Stone, D.M.D.
• Edmund Deforest Sugzdinis I, HEARING INSTRUMENT S

• Oral and Maxillofacial Surgery (Dentist) in Green Cove Springs, FL
• Providers in Green Cove Springs, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.