Matt St George Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2008014167 Issued in MO

Legal business name

MATT ST GEORGE INC

Doing business as

St George Family Dental

Practice address

603 Nichols St
Fulton, MO 65251-2650

Phone

(573) 642-6904

Fax

(573) 642-7256

NPI assigned

Mar 6, 2017

Organization subpart

No

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

Authorized official

Name

Matthew St George, DDSNPI 1992963839

Title

Owner

Phone

(573) 642-6904

Specialties & licenses 1

Addresses

Other names 1

• St George Family Dental Doing business as

Practitioners 2

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

• Matthew Paul St. George, DDS

  • Dentist
  • Toccoa, GA
  • NPI 1992963839
  NPD (past) Authorized official
• James M. McCall, D.D.S.

  • General Practice Dentistry
  • Fulton, MO
  • NPI 1528063625
  NPD (past)

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1336689660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 NICHOLS ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512650",
            "telephone_number": "573-642-6904",
            "fax_number": "573-642-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 NICHOLS ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512650",
            "telephone_number": "573-642-6904",
            "fax_number": "573-642-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT ST GEORGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-06",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "ST GEORGE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-642-6904",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2008014167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St George Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly J Malloy, PHARM.D.
• Jacqueline Suzette Maragh-Lawrence, APRN
• Kirsten Straub Marshall, PMHNP-BC
• Carissa Martin, PSY D
• Eric Martin, PH.D.
• Brian Gerard McAndrew Jr., MSW, LMSW
• James M. McCall, D.D.S.
• Jennifer McCann
• Luanne Wooten McClure, RPH
• Matthew R McClure, MD

• General Practice Dentistry in Fulton, MO
• Providers in Fulton, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; 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.