NPIMap

Individual provider Active NPI

Matthew Scott Killingsworth, D.M.D.

  • Pediatric Dentistry
  • Siloam Springs, AR
National Provider Identifier
1871887422
Registry record updated Jan 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
95 Issued in AR
Practice address
2125 E Main St Ste 13
Siloam Springs, AR 72761-5576
Phone
(479) 231-3005
Fax
(479) 282-0449
NPI assigned
May 31, 2011
Last updated
Jan 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3817 AR
Pediatric Dentistry 1223P0221X 95 AR Primary

Addresses

Primary practice location

2125 E Main St Ste 13
Siloam Springs, AR 72761-5576

Mailing address

2125 E Main St Ste 13
Siloam Springs, AR 72761-5576
Phone (479) 231-3005

Other practice location 1

1607 E Rainforest Rd
Fayetteville, AR 72703-5385
Phone (479) 582-0600

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

LicenseStateTypeSpecialty
3817ARMDDentist
95ARMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanders, Tompkins, Schiro, Landers and Sanders PLLC Pediatric Dentistry Past Accepting new patients
Ozark Pediatric Dentistry Pediatric Dentistry PastSince Jan 24, 2021 Accepting new patients
Triplett,Sanders,Tompkins, Smith & Landers #2 PLLC Dentist Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1306800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1871887422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 E MAIN ST STE 13",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727615576",
            "telephone_number": "479-231-3005",
            "fax_number": "479-282-0449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 E MAIN ST STE 13",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727615576",
            "telephone_number": "479-231-3005",
            "fax_number": "479-282-0449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1607 E Rainforest Rd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727035385",
            "country_code": "US",
            "telephone_number": "479-582-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILLINGSWORTH",
        "first_name": "MATTHEW",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-31",
        "last_updated": "2021-01-18",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "3817",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "95",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Siloam Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; 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.