Active NPI
Stephanie Shackelford, RDH
- Dental Hygienist
- Dallas, TX
National Provider Identifier
1952072241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 14103
- Practice address
- 3340 Longmeade Dr
Dallas, TX 75234-3748 - Phone
- (214) 995-9761
- NPI assigned
- Sep 26, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 14103 | TX | Primary |
Addresses
Primary practice location
3340 Longmeade Dr
Dallas, TX 75234-3748
Mailing address
3340 Longmeade Dr
Dallas, TX 75234-3748
Phone (214) 995-9761
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14103 | Other | TX | REGISTERED DENTAL HYGIENIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14103 | TX | MD | Rehabilitation Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632614400000",
"number": "1952072241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 LONGMEADE DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752343748",
"telephone_number": "214-995-9761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 LONGMEADE DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752343748",
"telephone_number": "214-995-9761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "STEPHANIE",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-26",
"last_updated": "2021-09-26",
"certification_date": "2021-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "TX",
"license": "14103",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED DENTAL HYGIENIST",
"identifier": "14103",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.