MAIN STREET DENTAL, LLC (NPI# 1154570448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154570448 |
| Entity Type | Organization |
| Organization Name | MAIN STREET DENTAL, LLC |
| Practice Address |
603 S Main St Pratt KS 67124-2630 |
| Practice Telephone | 6206729922 |
| Practice Fax Number | 6206729966 |
| Mailing Telephone | 6206729922 |
| Mailing Fax Number | 6206729966 |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2009-02-10 |
| Authorized Official Name | DR. JOHN D. MATHES (OWNER) |
| Authorized Official Telephone | 6206729922 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 60593 | KS | Dental Providers |
| Y | 122300000X | Dentist | 5971 | KS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 100222640A | 05 | |
| KS | BLUE CROSS & BLUE SHEILD | 116863 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588909642 | Main Street Dental, LLC | Clinic/Center | 201 W Main St, Vine Grove, KY 40175-1304 | 2012-11-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Main Street Dental, LLC | 330 Main Street, Canyon City, CO 81212 |
| Street Address |
603 S MAIN ST |
| City | PRATT |
| State | KS |
| Zip Code | 67124-2630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487270013 | Americare At Grand Plains Skilled Nursing and Rehabiltation LLC | Skilled Nursing Facility | 331 State Route 61, Pratt, KS 67124 | 2020-06-19 |
| 1275025264 | Steven M Kunz | Dentist | 501 S. Fincham, Pratt, KS 67124 | 2018-06-05 |
| 1972046266 | Hillary Sims | Developmental Therapist | 216 Curtis St., Pratt, KS 67124 | 2016-11-18 |
| 1215216122 | Kelli Gallagher | Occupational Therapist | 707 S High, Pratt, KS 67124 | 2011-08-09 |
| 1417193301 | Pratt Regional Medical Center Corp | Nurse Anesthetist, Certified Registered | 200 Commodore, Pratt, KS 67124 | 2008-12-23 |
| 1861511891 | Corey L. Neal | Specialist/Technologist | 348 Ne Sr 61, Pratt, KS 67124 | 2007-03-29 |
| 1588757454 | Dave J Johnston | Dentist | 219 S Ninnescah, Pratt, KS 67124 | 2006-10-02 |
| 1518060995 | William David Eastes | Chiropractor | 223 E 4th, Pratt, KS 67124 | 2006-09-07 |
| 1376646620 | Luis E Espinoza | Specialist | 124 Commodore St Ste B, Pratt, KS 67124 | 2006-09-05 |
| 1205809605 | John D Mathes | Dentist | 603 N Main, Pratt, KS 67124 | 2006-02-08 |
| Find all providers in zip 67124 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588757454 | Dave J Johnston | Dentist | 219 S Ninnescah, Pratt, KS 67124 | 2006-10-02 |
| 1205809605 | John D Mathes | Dentist | 603 N Main, Pratt, KS 67124 | 2006-02-08 |
| 1326171372 | Lee Ronald Ingram | Dentist | 105 W 4th St, Pratt, KS 67124-2605 | 2007-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659982759 | Brendan Daugherty | Dentist | 10040 Woodland Dr, Lenexa, KS 66220-3802 | 2020-08-12 |
| 1477164705 | Christopher Taylor Lippold | Dentist | 10 E 9th St Ste C, Lawrence, KS 66044-2600 | 2020-08-11 |
| 1164032090 | Brett Taylor Lyman | Dentist | 2215 Broadway Ave, Great Bend, KS 67530-3917 | 2020-08-05 |
| 1841809449 | Kailah Marie Willms | Dentist | 4111 W 6th St, Lawrence, KS 66049-4609 | 2020-07-29 |
| 1538778576 | Kelsie Cole | Dentist | 415 S 119th St W, Wichita, KS 67235-1816 | 2020-07-27 |
| 1457960452 | Nuvia Jeanette Lemus-diaz | Dentist | 2001 Central Ave, Dodge City, KS 67801-6410 | 2020-07-24 |
| 1851909329 | Michael Jay Somma | Dentist | 2838 N. Oliver Ave, Wichita, KS 67220 | 2020-07-21 |
| 1487262283 | Austin Rickabaugh | Dentist | 8911 State Ave, Kansas City, KS 66112-1645 | 2020-07-17 |
| 1356966352 | Paul Lewis | Dentist | 301 N Main St Ste 1420, Wichita, KS 67202-4814 | 2020-06-15 |
| 1225652332 | Jasmyn Christine Thole | Dentist | 401 S Clairborne Rd Ste A, Olathe, KS 66062-1735 | 2020-06-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.