Adam C. Matthias, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2016007792 Issued in MO

Practice address

3109 Frederick Ave
Suite a
St Joseph, MO 64506-2959

Phone

(816) 364-4774

Fax

(816) 364-4373

NPI assigned

Apr 2, 2012

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 2, 2021 through Aug 2, 2027

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1407112600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 FREDERICK AVE",
            "address_2": "SUITE A",
            "city": "ST JOSEPH",
            "state": "MO",
            "postal_code": "645062959",
            "telephone_number": "816-364-4774",
            "fax_number": "816-364-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 FREDERICK AVE",
            "address_2": "SUITE A",
            "city": "ST JOSEPH",
            "state": "MO",
            "postal_code": "645062959",
            "telephone_number": "816-364-4774",
            "fax_number": "816-364-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHIAS",
        "first_name": "ADAM",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-02",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2016007792",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40031764",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Martin, SLP-A
• Daniel Shashy Masin
• Sydney Masters, OD
• Orval Jeffrey Mather, PT
• Brent Allen Matthews, F-NP
• Morris C Matthias, CRNA
• Craig Mattox, D.C.
• Dixie Leah Mattthews
• Theresa Rene Maxwell, RN, MSN, FNP
• Chinakasiobi Mbata, DDS

• Oral and Maxillofacial Surgery (Dentist) in St Joseph, MO
• Providers in St Joseph, MO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.