NPIMap

Organization Active NPI

Riyan Dental LLC

Doing business as West Edgewood Dental

  • General Practice Dentistry
  • Jefferson City, MO
National Provider Identifier
1437810637
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RIYAN DENTAL LLC
Doing business as
West Edgewood Dental
Practice address
3306 Emerald LN
Jefferson City, MO 65109-6880
Phone
(573) 634-2222
NPI assigned
Jan 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Dr. Rajendar Matta, DMDNPI 1780814954
Title
President
Phone
(205) 617-7417

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3306 Emerald LN
Jefferson City, MO 65109-6880

Mailing address

14031 Willow Dr
Clive, IA 50325-8317
Phone (205) 617-7417

Other practice location 1

3306 Emerald Ln
Jefferson City, MO 65109-6880
Phone (573) 624-2222

Other names 1

  • WEST EDGEWOOD DENTAL Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1437810637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14031 WILLOW DR",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258317",
            "telephone_number": "205-617-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3306 EMERALD LN",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096880",
            "telephone_number": "573-634-2222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3306 Emerald Ln",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651096880",
            "country_code": "US",
            "telephone_number": "573-624-2222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RIYAN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "RAJENDAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-617-7417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WEST EDGEWOOD DENTAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WEST EDGEWOOD DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.