Matthew Theriac, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEO 15187 Issued in MO

Practice address

905 Jackson St
Macon, MO 63552-2016

Phone

(660) 385-3623

Fax

(660) 385-3526

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Matthew Theriac, D.D.S. LLC

  • Health Maintenance Organization
  • Macon, MO
  • NPI 1760679401
  NPD (past) Authorized official

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831269158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 JACKSON ST",
            "city": "MACON",
            "state": "MO",
            "postal_code": "635522016",
            "telephone_number": "660-385-3623",
            "fax_number": "660-385-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 JACKSON ST",
            "city": "MACON",
            "state": "MO",
            "postal_code": "635522016",
            "telephone_number": "660-385-3623",
            "fax_number": "660-385-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIAC",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "DEO 15187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon M Sims, RDH
• Lillian M Snider, MA, LPC
• Clifford Strupp, MD, MBA
• Surgical Care Center, LLC
• Jason Lee Taylor, PHARM D
• Thomas Thurman, D.C.
• Vision Care Associates, LLC
• Wal-Mart Stores East LP
• Karyn Leslie Walters, PTA
• Lacey Chantelle Watts

• General Practice Dentistry in Macon, MO
• Providers in Macon, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.