Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1578574240 Deactivated / Inactive NPI Male Practitioner

Dr. Stephen C Waller , DDS

Dentist • Ellington, MO

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Stephen Waller has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 10, 2006
NPI Deactivation Date March 23, 2017
Total Practice Duration ~11 Years of Practice (2006 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Stephen Waller, DDS was a registered Dentist practicing in Ellington, MO. Throughout an active medical career spanning 11 years, Dr. Waller provided care at the practice location at 115 WALNUT ST until profile deactivation on 2017-03-23.

Practice Location & Contact Primary Location

Practice Address

115 Walnut St

Ellington, MO 636380157

Telephone 5736633177
Fax 5736633188
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Ellington, MO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 9.6 Yrs
Regional Practice Density
3 Specialists

Practicing in Ellington, MO (1740 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License MO 1999135982

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Stephanie Bland , RDH

Dental Hygienist

NPI 1023510906

Registered Dental Hygienist

Meagan Berry , RHD

Dental Hygienist

NPI 1033420039
Dr. Bradley Daniel , DMD

Dentist - General Practice

NPI 1316293145

Doctor of Dental Medicine

Jenny Russell

Dental Assistant

NPI 1356437024
Jeanie Mcclanahan

Dental Assistant

NPI 1376637728
NPI 1487861936

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated March 23, 2017

Record deactivated on March 23, 2017

NPI Profile Active July 08, 2009

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2009

Registered at 115 WALNUT ST, ELLINGTON, MO 636380157 (Tel: 5736633177)

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Updated Business Mailing Address July 08, 2009

Registered at PO BOX 157, ELLINGTON, MO 636380157 (Tel: 5736632313)

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Provider Name / Credentials Updated July 08, 2009

Recorded as STEPHEN WALLER, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2009

Dentist (License #1999135982 in MO)

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Initial NPI Registration & Enumeration August 10, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1578574240
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 10, 2006
Last Update: July 08, 2009
Deactivation Date: March 23, 2017

Mailing Address

Po Box 157

Ellington, MO 636380157

Phone: 5736632313

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.