Matthew E Church, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12010045 Issued in KY

Practice address

10935 E Washington St Ste a
Indianapolis, IN 46229-3182

Phone

(317) 890-4455

Fax

(317) 890-4460

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Washington Street Dentistry Inc.

  • Dentist
  • Indianapolis, IN
  • NPI 1225286099
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1033127063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10935 E WASHINGTON ST STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293182",
            "telephone_number": "317-890-4455",
            "fax_number": "317-890-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10935 E WASHINGTON ST STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293182",
            "telephone_number": "317-890-4455",
            "fax_number": "317-890-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "MATTHEW",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "12010045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Chung, DDS
• Yoonho Chung
• Patricia Chunn, MS CCC-SP
• Callie Chunodkar, LMHC
• Jessica Church, FNP-C
• Sara Church, LMHC
• Dennis Lee Churchill II, M.D.
• Peter Chwedyk, RBT
• Donato Ciaccia, MD
• Julie A Ciaccia, NP

• Dentist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.