Active NPI
Courtney Bueler Matchett, DDS
- General Practice Dentistry
- Hannibai, MO
National Provider Identifier
1497323240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2021018838
- Practice address
- 2727 St. Mary'S Ave
Hannibai, MO 63401 - Phone
- (573) 221-1227
- Fax
- (573) 221-5564
- NPI assigned
- Jun 16, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 2021018838 | MO | Primary |
Addresses
Primary practice location
2727 St. Mary'S Ave
Hannibai, MO 63401
Mailing address
2727 St. Mary'S Ave
Hannibai, MO 63401
Phone (573) 221-1227
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 |
|---|---|---|---|
| 2021018838 | MO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hannibal Dental Group | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1497323240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2727 ST. MARY'S AVE",
"city": "HANNIBAI",
"state": "MO",
"postal_code": "63401",
"telephone_number": "573-221-1227",
"fax_number": "573-221-5564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2727 ST. MARY'S AVE",
"city": "HANNIBAI",
"state": "MO",
"postal_code": "63401",
"telephone_number": "573-221-1227",
"fax_number": "573-221-5564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATCHETT",
"first_name": "COURTNEY",
"middle_name": "BUELER",
"name_prefix": "Mrs.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-16",
"last_updated": "2021-06-16",
"certification_date": "2021-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2021018838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.