NPIMap

Organization Active NPI

Main Street Dental, LLC

  • Dentist
  • Pratt, KS
National Provider Identifier
1154570448
Registry record updated Feb 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5971 Issued in KS
Legal business name
MAIN STREET DENTAL, LLC
Practice address
603 S Main St
Pratt, KS 67124-2630
Phone
(620) 672-9922
Fax
(620) 672-9966
NPI assigned
Sep 11, 2008
Last updated
Feb 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2009

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

Authorized official

Name
Dr. John D. Mathes, DDSNPI 1205809605
Title
Owner
Phone
(620) 672-9922

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 60593 KS
Dentist 122300000X 5971 KS Primary

Addresses

Primary practice location

603 S Main St
Pratt, KS 67124-2630

Mailing address

603 S Main St
Pratt, KS 67124-2630
Phone (620) 672-9922

Other identifiers 2

IdentifierTypeStateIssuer
100222640AMedicaidKS
116863OtherKSBLUE CROSS & BLUE SHEILD

National Provider Directory

National Provider Directory

Locations

603 S Main St
Pratt, KS 67124
Phone (620) 672-9922

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234224000000",
    "number": "1154570448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 S MAIN ST",
            "city": "PRATT",
            "state": "KS",
            "postal_code": "671242630",
            "telephone_number": "620-672-9922",
            "fax_number": "620-672-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 S MAIN ST",
            "city": "PRATT",
            "state": "KS",
            "postal_code": "671242630",
            "telephone_number": "620-672-9922",
            "fax_number": "620-672-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2009-02-10",
        "status": "A",
        "authorized_official_last_name": "MATHES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-672-9922",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "60593",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "5971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100222640A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHEILD",
            "identifier": "116863",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pratt, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2009; 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.