Madison Diaz, DDS
Individual provider Active NPI General Practice Dentistry · Lexington, MO
NPI 1891362067 · NPPES record last updated Jan 17, 2024
Key facts
- NPI
- 1891362067
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2021019490 (MO)
- Practice address
- 811 S Business Highway 13 Ste a
Lexington, MO 64067-1572 - Phone
- (660) 251-6440
- NPI assigned
- Jun 7, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210714002983 | MO | Practitioner - Dentist | 2769884626 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kansas City Care Clinic | Current |
Accepting new patients | |
| Kansas City Care Clinic | Current |
Accepting new patients |
Locations
3515 Broadway Blvd
Kansas City, MO 64111
Phone (816) 753-5144
2340 E Meyer Blvd
Ste 200
Kansas City, MO 64132
Phone (816) 753-5144
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2021019490 | MO | Yes |
Addresses
Primary practice location
811 S Business Highway 13 Ste a
Lexington, MO 64067-1572
Mailing address
4911 Mercier St
Kansas City, MO 64112-1308
Phone (913) 633-0061
Other providers in Lexington, MO
- Robert Thomas Caffrey
- Center for Counseling & Training LLC
- City of Lexington
- Thomas R Corporon
- Laci Jade Crosson
- Amy Dobson
- Dana H Duckworth
- Cody Ellison
- Evolve Chiropractic LLC
- Family Health Medical
All providers in Lexington, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.