Stephen McKown Matthews, D.D.S.
Individual provider Active NPI General Practice Dentistry · Potosi, MO
NPI 1225199342 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1225199342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 014735 (MO)
- Practice address
- 200 Health Way Dr
Suite 1
Potosi, MO 63664-1434 - Phone
- (573) 436-0300
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150615002108 | MO | Order and Referring Only - Dentist |
5799096921 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014735 | MO | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 014735 | MO | Yes |
Addresses
Primary practice location
200 Health Way Dr
Suite 1
Potosi, MO 63664-1434
Mailing address
801 Selma Ave
Webster Groves, MO 63119-4166
Other providers in Potosi, MO
- Marianne Klemm
- Edward William Lake
- Carolyn Coyne Maryan
- Christopher Ryan Massey
- Heather Renee Mathieson
- Tiara Michele McCarthy
- Judith McCaul
- Jensen Ryan McGinness
- Tommi McMahan
- Nancy Lee McNail
All providers in Potosi, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.