Active NPI
Paul Thomas Matlock, D.D.S.
- Dentist
- Lees Summit, MO
National Provider Identifier
1174740997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 015728
- Practice address
- 301 NE Mulberry St
Suite 205
Lees Summit, MO 64086-6031 - Phone
- (816) 246-4920
- Fax
- (816) 246-4970
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 015728 | MO | Primary |
Addresses
Primary practice location
301 NE Mulberry St
Suite 205
Lees Summit, MO 64086-6031
Mailing address
301 NE Mulberry St
Suite 205
Lees Summit, MO 64086-6031
Phone (816) 246-4920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015728 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344297600000",
"number": "1174740997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 NE MULBERRY ST",
"address_2": "SUITE 205",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640866031",
"telephone_number": "816-246-4920",
"fax_number": "816-246-4970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 NE MULBERRY ST",
"address_2": "SUITE 205",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640866031",
"telephone_number": "816-246-4920",
"fax_number": "816-246-4970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATLOCK",
"first_name": "PAUL",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2012-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "015728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.