Active NPI
Matt McCoy, D.D.S., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Idaho Falls, ID
National Provider Identifier
1750747077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- D4719
- Practice address
- 3411 Merlin Dr
Idaho Falls, ID 83404-7430 - Phone
- (801) 440-6849
- NPI assigned
- Jan 4, 2016
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | D4719 | ID | Primary |
Addresses
Primary practice location
3411 Merlin Dr
Idaho Falls, ID 83404-7430
Mailing address
596 Taylor LN
Chubbuck, ID 83202-2380
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4719 | ID | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451865600000",
"number": "1750747077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "596 TAYLOR LN",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832022380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3411 MERLIN DR",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047430",
"telephone_number": "801-440-6849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOY",
"first_name": "MATT",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-04",
"last_updated": "2016-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "ID",
"license": "D4719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.