Matthew David Whitesides, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9976 Issued in CO

Practice address

100 N 11TH Ave
Greeley, CO 80631-2011

Phone

(970) 313-0353

Fax

(970) 351-7075

NPI assigned

Jul 17, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1366672875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-350-4606",
            "fax_number": "970-350-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N 11TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806312011",
            "telephone_number": "970-313-0353",
            "fax_number": "970-351-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITESIDES",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-17",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "9976",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "9976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65000846",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Michelle White, PT, DPT, MS
• Kelsie White, MS
• Kristie P White, PHARM.D.
• Nicholas C White, BA
• Samuel White, RBT
• James Whiting Jr.
• Nikki Jean Whiting, NP
• Tara Whittemore
• Ashley Michelle Whyte-Rayson, M.D.
• Marlene Whyte, LSW

• Pediatric Dentistry in Greeley, CO
• Providers in Greeley, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; 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.