Matthew Evan Connell, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

2016017394 Issued in MO

Practice address

1497 N Business Route 5
Camdenton, MO 65020-2636

Phone

(573) 346-7278

Fax

(573) 346-2176

NPI assigned

May 31, 2016

Last updated

May 31, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Dental Clinic LLC

  • General Practice Dentistry
  • Camdenton, MO
  • NPI 1720141849
  NPD (past)

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1780032763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "650200820",
            "telephone_number": "573-346-7278",
            "fax_number": "573-346-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 N BUSINESS ROUTE 5",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "650202636",
            "telephone_number": "573-346-7278",
            "fax_number": "573-346-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELL",
        "first_name": "MATTHEW",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2016017394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alex Clarke, DO
• Paul H Compney, FNP
• Gail Compton, NP
• Kimberly Brooke Conde, PSY.D.
• Evan K Connell, DDS
• Christine Cooper, MA, PLPC
• County of Camden
• Dillon Companies LLC (Gerbes Pharmacy)
• Brittany M Domagalski, PHARMD
• Harlan Lance Dye, D.C.

• Dentist in Camdenton, MO
• Providers in Camdenton, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.