Individual provider Active NPI

Matthew Amaral Rodrigues, DDS

  • Dentist
  • Kansas City, MO
National Provider Identifier
1194610261
Registry record updated Oct 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2025019829 Issued in MO
Practice address
4103 NW Barry Rd
Kansas City, MO 64154-1100
Phone
(816) 741-6200
NPI assigned
Jun 10, 2025
Last updated
Oct 18, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 62330 KS
Dentist 122300000X 2025019829 MO Primary

Addresses

Primary practice location

4103 NW Barry Rd
Kansas City, MO 64154-1100

Mailing address

206 Richardson St
PO Box 135
Smithville, MO 64089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20250913000102 MO Order and Referring Only - DentistPractitioner - Dentist 5890298970

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
62330KSMDDentist
2025019829MOMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Alex R Sharifian DDS, New Mark Modern Dentistry, PC CurrentSince Jun 15, 2025 Accepting new patients
Kirby L Kavanaugh DDS LLC PastSince Jul 9, 2023 Accepting new patients

Locations

9350 N Oak Trfy
Kansas City, MO 64155
Phone (816) 400-4045

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1749513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792281600000",
    "number": "1194610261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 RICHARDSON ST",
            "address_2": "PO BOX 135",
            "city": "SMITHVILLE",
            "state": "MO",
            "postal_code": "64089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 NW BARRY RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641541100",
            "telephone_number": "816-741-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUES",
        "first_name": "MATTHEW",
        "middle_name": "AMARAL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-10",
        "last_updated": "2026-10-18",
        "certification_date": "2026-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "62330",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2025019829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.