Active NPI
Kenneth Joseph Stavisky, DMD
- Dentist
- South Burlington, VT
National Provider Identifier
1962512038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0160001242
- Practice address
- 99 Swift St
Suite 115
South Burlington, VT 05403-7324 - Phone
- (802) 865-1212
- Fax
- (802) 865-4666
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0160001242 | VT | Primary |
Addresses
Primary practice location
99 Swift St
Suite 115
South Burlington, VT 05403-7324
Mailing address
99 Swift St
Suite 115
South Burlington, VT 05403-7324
Phone (802) 865-1212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 867774 | Other | TRICARE UNITED CONCORDIA |
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 |
|---|---|---|---|
| 0160001242 | VT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Kenneth J. Stavisky, LTD. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Endodontics
- South Burlington, VT
- NPI 1942384979
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962512038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 SWIFT ST",
"address_2": "SUITE 115",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054037324",
"telephone_number": "802-865-1212",
"fax_number": "802-865-4666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 SWIFT ST",
"address_2": "SUITE 115",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054037324",
"telephone_number": "802-865-1212",
"fax_number": "802-865-4666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAVISKY",
"first_name": "KENNETH",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VT",
"license": "0160001242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE UNITED CONCORDIA",
"identifier": "867774",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in South Burlington, VT
Sources for this page
- 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.