Mathew S. Ausmus, DDS
Individual provider Active NPI Pediatric Dentistry · Rolla, MO
NPI 1518957778 · NPPES record last updated Aug 22, 2019
Key facts
- NPI
- 1518957778
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 014015 (MO)
- Practice address
- 1050 W 10TH St
Rolla, MO 65401 - Phone
- (573) 426-2233
- Fax
- (573) 364-3993
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014015 | MO | MD | Pediatric Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 014015 | MO | Yes |
Addresses
Primary practice location
1050 W 10TH St
Rolla, MO 65401
Mailing address
PO Box 579
Rolla, MO 65402
Phone (573) 458-3425
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 408413003 | Medicaid | MO |
Other providers in Rolla, MO
- John Ashton Armstrong
- Marikay Lou Asberry
- Julian Ategeka
- Steven Thomas Atkinson
- Mary Jane Aufdengarten
- Terry Bryan Austin
- Amanda L Bahr
- Casey Rhae Ball
- Ryan James Ballard
- Steven R Ballard
All providers in Rolla, MO · Pediatric Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.