Active NPI
Jyothsna Meda, DMD
- General Practice Dentistry
- Rolla, MO
National Provider Identifier
1235658238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2017031391
- Practice address
- 1050 W 10TH St Ste 520
Rolla, MO 65401-2905 - Phone
- (573) 426-2233
- Fax
- (573) 202-2450
- NPI assigned
- Sep 12, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2017031391 | MO | Primary |
Addresses
Primary practice location
1050 W 10TH St Ste 520
Rolla, MO 65401-2905
Mailing address
1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 426-2233
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017031391 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1235658238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 W 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012905",
"telephone_number": "573-426-2233",
"fax_number": "573-202-2450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W 10TH ST STE 520",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012905",
"telephone_number": "573-426-2233",
"fax_number": "573-202-2450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDA",
"first_name": "JYOTHSNA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-12",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2017031391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.