Matthew Jonathon Vaillant, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11524 Issued in MN

Practice address

421 W 4TH St
Red Wing, MN 55066-2555

Phone

(651) 388-6709

NPI assigned

Nov 13, 2006

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 12, 2015 through Aug 12, 2027

Medicare enrollment (NPD)

Enrolled

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.

• Vaillant Dental Services, LLC

  dba Vaillant Family Dental

  • General Practice Dentistry
  • Red Wing, MN
  • NPI 1326243114
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982776449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16699 FARRAGO TRL",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550247830",
            "telephone_number": "952-997-7123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W 4TH ST",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662555",
            "telephone_number": "651-388-6709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAILLANT",
        "first_name": "MATTHEW",
        "middle_name": "JONATHON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Total Renal Care Inc
• Erwin Thomas Tucker, LADC
• Samantha Ann Tufenk, NREMT
• Vaillant Dental Services, LLC (Vaillant Family Dental)
• Dennis P. Vaillant, DDS
• Melissa Marlene Vargas
• Stefanie L Vette, PA-C
• Madison Marie Victorian, PA-C
• Abby Janelle Villaran, LMFT
• Priscilla Quynh-Phuong Vu, MD

• General Practice Dentistry in Red Wing, MN
• Providers in Red Wing, MN by specialty
• General Practice Dentistry in Minnesota

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.