Matteson Orthodontics MDPC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021002232 Issued in IL

Legal business name

MATTESON ORTHODONTICS MDPC

Practice address

4440 Lincoln Hwy
Suite 300
Matteson, IL 60443-2349

Phone

(708) 481-6086

Fax

(708) 481-2525

NPI assigned

Jun 1, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Keyur A Shah, DDS, MS

Title

President

Phone

(708) 481-6086

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Matteson Orthodontics MDPC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Matteson Orthodontics MDPC

  • Dental Clinic/Center
  • Matteson, IL
  • NPI 1295058998
  NPD tax ID

Practitioners 1

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

• Robert J Manasse, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Matteson, IL
  • NPI 1023224243
  NPD (past)

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

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1588958177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 LINCOLN HWY",
            "address_2": "SUITE 300",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432349",
            "telephone_number": "708-481-6086",
            "fax_number": "708-481-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 LINCOLN HWY",
            "address_2": "SUITE 300",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432349",
            "telephone_number": "708-481-6086",
            "fax_number": "708-481-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTESON ORTHODONTICS MDPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-01",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "KEYUR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-481-6086",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021002232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HFS DENTAL PROGRAM",
            "identifier": "19025814",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Signora Marshall
• Melissa L Mathis, ATC
• Olufemi Matimoju
• Matteson MRI Inc
• Matteson Orthodontics MDPC
• Matteson School District 162
• Marcus Matthews, OTR/L
• Maxim Healthcare Services, Inc.
• Mays & Associates Full Court Program LLC
• Mays and Associates, Inc.

• Orthodontics and Dentofacial Orthopedics Dentistry in Matteson, IL
• Providers in Matteson, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; 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.