Summit Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2006037222 Issued in MO

Legal business name

SUMMIT PEDIATRIC DENTISTRY

Practice address

24 NW Chipman Rd Ste B
Lees Summit, MO 64063-1929

Phone

(816) 256-0073

NPI assigned

May 17, 2017

Organization subpart

No

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

Authorized official

Name

Moncy Mathew, DDS

Title

Owner/Dentist

Phone

(816) 256-0073

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053848374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 NW CHIPMAN RD STE B",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640631929",
            "telephone_number": "816-256-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 NW CHIPMAN RD STE B",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640631929",
            "telephone_number": "816-256-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MATHEW",
        "authorized_official_first_name": "MONCY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "816-256-0073",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "2006037222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841474293",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summit Integrative Dental (Bromley, D.D.S. and Broyles, D.D.S.), P.C. (Summit Integrative Dental)
• Summit Lakes Dental Care, L.L.C. (Summit Lakes Dental Care)
• Summit Medical
• Summit Medical Associates LLC
• Summit of Health Integrative Care, Chiropractic and Hyperbaric Center
• Summit Pediatric Therapy Corp
• Summit Pediatrics, LLC
• Summit Plastic Surgery Inc
• Summit Rehabilitation and Wellness Center, LLC
• Summit Ridge Counseling Group, Inc

• Pediatric Dentistry in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.