Matthew Bridwell DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MATTHEW BRIDWELL DDS PA

Doing business as

Kanis Dental

Practice address

10809 Kanis Rd Ste 500
Little Rock, AR 72211-3826

Phone

(501) 244-3500

Fax

(501) 244-3501

NPI assigned

Mar 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Matthew H Bridwell, DDS

Title

President/Dentist

Phone

(501) 269-6811

Specialties & licenses 1

Addresses

Other names 1

• Kanis Dental Doing business as

Locations

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1538400841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SIENNA LAKE CV",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722103717",
            "telephone_number": "501-244-3500",
            "fax_number": "501-244-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10809 KANIS RD STE 500",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113826",
            "telephone_number": "501-244-3500",
            "fax_number": "501-244-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW BRIDWELL DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "BRIDWELL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "501-269-6811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kanis Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christian Michael Casson Matishak, MD
• Alex Elaine Matlock, APRN
• David Neil Matlock Jr., MD
• Kellee Matlock, CRNA
• Shelby Elizabeth Matros
• Amber Nicole Matthews, MSN, APN, FNP
• Dwayne Rashun Matthews
• Jaela Matthews
• Lacey Matthews, PSY.D.
• Lakeisha D Matthews, LMSW

• General Practice Dentistry in Little Rock, AR
• Providers in Little Rock, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; 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.