Chad Clifton Street, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7103 Issued in KY

Practice address

129 Loraine St
Pikeville, KY 41501-3757

Phone

(606) 432-9639

Fax

(606) 432-9689

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1992715288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 LORAINE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013757",
            "telephone_number": "606-432-9639",
            "fax_number": "606-432-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 LORAINE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013757",
            "telephone_number": "606-432-9639",
            "fax_number": "606-432-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREET",
        "first_name": "CHAD",
        "middle_name": "CLIFTON",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7103",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "38532",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64068414",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002300",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA PROVIDER #",
            "identifier": "1204662",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Blake Stewart, PHARMD
• Edward G. Stiles, D.O.
• James Randall Stilles, R.PH.
• Stephanie Stiltner
• Kellie J Stivers, MD
• Matthew L. Sullivan, CRNA
• Janet E Summers, O.D.
• Sunrise Children'S Services, Inc.
• Sunrise Children'S Services, Inc.
• Worawute Supaongprapa, MD

• Oral and Maxillofacial Surgery (Dentist) in Pikeville, KY
• Providers in Pikeville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.