Active NPI
Matthew Kelly Keider
- General Practice Dentistry
- Winston Salem, NC
National Provider Identifier
1720151400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6236
- Practice address
- 3610 Westgate Center Cir
Winston Salem, NC 27103-2935 - Phone
- (336) 768-0480
- Fax
- (336) 760-5525
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- 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 | 6236 | NC | Primary |
Addresses
Primary practice location
3610 Westgate Center Cir
Winston Salem, NC 27103-2935
Mailing address
3610 Westgate Center Cir
Winston Salem, NC 27103-2935
Phone (336) 768-0480
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902884943 | Other | NC | NPI - NATIONAL PROVIDER |
| 131195 | Other | NC | UNITED CONCORDIA PROV # |
| 94792 | Other | NC | BCBS PROVIDER NUMBER |
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 |
|---|---|---|---|
| 6236 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Matthew K Keider DDS PA | 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.
-
- Dental Clinic/Center
- Winston Salem, NC
- NPI 1902884943
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332374400000",
"number": "1720151400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3610 WESTGATE CENTER CIR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271032935",
"telephone_number": "336-768-0480",
"fax_number": "336-760-5525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3610 WESTGATE CENTER CIR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271032935",
"telephone_number": "336-768-0480",
"fax_number": "336-760-5525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEIDER",
"first_name": "MATTHEW",
"middle_name": "KELLY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2012-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "6236",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI - NATIONAL PROVIDER",
"identifier": "1902884943",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROV #",
"identifier": "131195",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "94792",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.