Individual provider Active NPI

Matthew D Vanzanten, DDS

  • General Practice Dentistry
  • Wheelersburg, OH
National Provider Identifier
1023354149
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30025116 Issued in OH
Practice address
11862 Gallia Pike
Wheelersburg, OH 45694-8437
Phone
(740) 574-1515
NPI assigned
Dec 18, 2012
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30025116 OH Primary

Addresses

Primary practice location

11862 Gallia Pike
Wheelersburg, OH 45694-8437

Mailing address

11862 Gallia Pike
Wheelersburg, OH 45694-8437
Phone (740) 574-1515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161117002441 KY Order and Referring Only - DentistPractitioner - Dentist 8426337270

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30025116OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Matthew Vanzanten DDS General Practice CurrentSince Nov 3, 2024 Accepting new patients
H David O'Donnell DMD PSC PastSince Sep 29, 2019 Accepting new patients
Matthew D Vanzanten DDS GPS PLLC General Practice PastSince Nov 3, 2024 Accepting new patients

Locations

11862 Gallia Pike
Wheelersburg, OH 45694
Phone (740) 574-1515

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1023354149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11862 GALLIA PIKE",
            "city": "WHEELERSBURG",
            "state": "OH",
            "postal_code": "456948437",
            "telephone_number": "740-574-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11862 GALLIA PIKE",
            "city": "WHEELERSBURG",
            "state": "OH",
            "postal_code": "456948437",
            "telephone_number": "740-574-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANZANTEN",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-18",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30025116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheelersburg, OH

Sources for this page

Verify at the official NPI Registry.