NPIMap

Organization Active NPI

Missouri Dental Professionals, Richard Straus, DMD, PC

  • General Practice Dentistry
  • Sullivan, MO
National Provider Identifier
1194945246
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Practice address
413 Walmart Dr
Sullivan, MO 63080-3327
Phone
(573) 468-3289
Fax
(573) 468-3303
NPI assigned
Apr 30, 2007
Organization subpart
Yes
Parent organization
MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

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

Authorized official

Name
Kendra Walker
Title
Credentialing Team Lead
Phone
(217) 540-8513

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

413 Walmart Dr
Sullivan, MO 63080-3327

Mailing address

413 Wal-Mart Dr
Sullivan, MO 63080-3327
Phone (573) 468-3289

Other names 1

  • Sullivan Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Family Dental Care of Missouri - Richard E Workman DMD PC60 organizations share this tax ID, including this one
Part of
Heartland Family Dental Care of Missouri - Richard E Workman DMD PC

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

413 Walmart Dr
Sullivan, MO 63080
Phone (573) 468-3289

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524614400000",
    "number": "1194945246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 WAL-MART DR",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630803327",
            "telephone_number": "573-468-3289",
            "fax_number": "573-468-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 WALMART DR",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630803327",
            "telephone_number": "573-468-3289",
            "fax_number": "573-468-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC",
        "enumeration_date": "2007-04-30",
        "last_updated": "2018-04-25",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8513"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sullivan, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; 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.