DR. STEPHEN C. WALLER, DDS, LLC (NPI# 1992984173) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992984173 |
| Entity Type | Organization |
| Organization Name | DR. STEPHEN C. WALLER, DDS, LLC |
| Practice Address |
115 Walnut St Ellington MO 63638 |
| Mailing Address |
Po Box 157 110 S. 2nd St Ellington MO 63638-0157 |
| Practice Telephone | 5737564344 |
| Practice Fax Number | 5737564699 |
| Mailing Telephone | 5736632313 |
| Mailing Fax Number | 5736632322 |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2009-01-22 |
| Authorized Official Name | DR. STEPHEN C. WALLER (DENTIST) |
| Authorized Official Telephone | 5737564344 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
1999135982 | MO | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | TYPE 1 NPI NUMBER | 1578574240 | 01 |
| Street Address |
115 WALNUT ST |
| City | ELLINGTON |
| State | MO |
| Zip Code | 63638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770678211 | Big Springs Medical Association | Clinic/Center | 115 Walnut St, Ellington, MO 63638 | 2006-10-03 |
| 1033420039 | Meagan Whitley Berry | Dental Hygienist | 115 Walnut St, Ellington, MO 63638 | 2010-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831398858 | Linda Lee Potter | Counselor | 125 A Temple St, Ellington, MO 63638 | 2007-07-11 |
| 1942424254 | Iris Fae Ross | Counselor | 110 N. Second St., Ellington, MO 63638 | 2007-04-11 |
| 1700916400 | Southern Reynolds Rii | Speech-Language Pathologist | One School Street, Ellington, MO 63638 | 2007-03-06 |
| 1467533604 | Sherilyn K Clark | Registered Nurse | 110 S. 2nd St., Ellington, MO 63638 | 2006-10-17 |
| 1376637728 | Jeanie Larue Mcclanahan | Dental Assistant | 115 Walnut St., Ellington, MO 63638 | 2006-10-02 |
| 1730450156 | Tasha Lynn Wisdom | Social Worker | 315 E Walnut St, Ellington, MO 63638 | 2012-01-17 |
| 1689814329 | Healthpro Physical Therapy LLC | Clinic/Center | 315 East Walnut, Ellington, MO 63638 | 2009-02-20 |
| 1770664906 | Stacey Keeney | Registered Nurse | 205 Walnut St., Ellington, MO 63638 | 2006-10-17 |
| 1295816437 | Deeanna Lynn Freeman | Registered Nurse | 110 S. 2nd St., Ellington, MO 63638 | 2006-10-17 |
| 1356437024 | Jenny S. Russell | Dental Assistant | 115 Walnut St., Ellington, MO 63638 | 2006-10-04 |
| Find all providers in zip 63638 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932494903 | Johathan A Zahner | Dentist | 3 Main St, Ellington, CT 06029-3317 | 2011-06-17 |
| 1730390352 | Ellington Dental Associates, P.C. | Dentist | 175 West Rd, Ellington, CT 06029-3730 | 2007-05-25 |
| 1750597050 | Steven Jay Landman | Dentist | 175 West Rd, Ellington, CT 06029-3730 | 2007-05-15 |
| 1790991008 | Joann Lois Vallera | Dentist | 175 West Rd, Ellington, CT 06029-3730 | 2007-05-15 |
| 1760535231 | Zahner Dental, LLC | Dentist | 3 Main St, Ellington, CT 06029-3317 | 2007-01-19 |
| 1801985411 | Shawn D. Zahner | Dentist | 3 Main St, Ellington, CT 06029-3317 | 2006-10-12 |
| 1538258124 | Warren L. Zahner | Dentist | 3 Main St, Ellington, CT 06029-3317 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194322990 | Wildhorse Dental Care, LLC | Dentist | 399 Patriotic Trl, Weldon Spring, MO 63304-7936 | 2020-10-05 |
| 1801493762 | Alexander Ahmadi | Dentist | 4171 Crescent Dr Ste 102, Saint Louis, MO 63129-3645 | 2020-10-05 |
| 1184239832 | Adam Wesley Gadbois | Dentist | 220 Diego Dr, Columbia, MO 65203-4919 | 2020-09-10 |
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1538778592 | Maya Grace Habibi | Dentist | 5212 N Service Rd, Saint Peters, MO 63376-3950 | 2020-07-27 |
| 1427667500 | Breakthrough Dental Partners LLC | Dentist | 401 E Mechanic St, Harrisonville, MO 64701-2427 | 2020-07-24 |
| 1396353876 | Michael Rehme Jr. | Dentist | 2821 N Ballas Rd Ste 245, Saint Louis, MO 63131-2378 | 2020-07-21 |
| 1790303774 | Wed Khizirpour | Dentist | 1680 Nw Chipman Rd, Lees Summit, MO 64081-3934 | 2020-07-07 |
| 1275150716 | Hills Dentistry LLC | Dentist | 2000 Kentucky Ave Ste C, Platte City, MO 64079-7714 | 2020-07-01 |
| 1134745227 | Kayla White | Dentist | 1401 Forum Blvd Ste 203, Columbia, MO 65203-1915 | 2020-06-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.