Nicole Marie Matthews, DDS
Individual provider Active NPI Dentist · New Haven, MO
NPI 1174981997 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1174981997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2016017389 (MO)
- Practice address
- 1009 Highway C
New Haven, MO 63068-1425 - Phone
- (573) 237-3038
- NPI assigned
- Feb 8, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160808002118 | NM | Order and Referring Only - Dentist |
6507150992 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016017389 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Better Sleep Missouri LLC | Current |
Accepting new patients |
Locations
1009 Highway C
New Haven, MO 63068
Phone (573) 237-3038
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NM | ||
| Dentist | 122300000X | 2016017389 | MO | Yes |
Addresses
Primary practice location
1009 Highway C
New Haven, MO 63068-1425
Mailing address
1009 Highway C
New Haven, MO 63068-1425
Phone (573) 237-3038
Other providers in New Haven, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.