Vlada Matytsin, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

051337 Issued in NY

Practice address

4840 Sweetwater Blvd Ste a
Sugar Land, TX 77479

Phone

(832) 939-9999

Fax

(832) 939-9997

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

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.

• FWB Dental

  • General Practice Dentistry
  • Houston, TX
  • NPI 1245770148
  NPD (past) Authorized official
• FWB Dental P.L.L.C.

  • General Practice Dentistry
  • Sugar Land, TX
  • NPI 1366982324
  NPD (past) Authorized official
• FWB Dental, P.L.L.C.

  • General Practice Dentistry
  • Friendswood, TX
  • NPI 1013458983
  NPD (past) Authorized official
• Baybrook Mall Dental PC

  • General Practice Dentistry
  • Friendswood, TX
  • NPI 1861732273
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1003964339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 SWEETWATER BLVD STE A",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774793403",
            "telephone_number": "832-939-9999",
            "fax_number": "832-939-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 SWEETWATER BLVD STE A",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "77479",
            "telephone_number": "832-939-9999",
            "fax_number": "832-939-9997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1684 Willowbrook Mall",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770706027",
            "country_code": "US",
            "telephone_number": "281-955-5558",
            "fax_number": "281-955-8763",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1012 Baybrook Mall",
            "address_purpose": "LOCATION",
            "city": "Friendswood",
            "state": "TX",
            "postal_code": "775462744",
            "country_code": "US",
            "telephone_number": "281-461-6515",
            "fax_number": "281-461-6687",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16535 Southwest Fwy Ste 570",
            "address_purpose": "LOCATION",
            "city": "Sugar Land",
            "state": "TX",
            "postal_code": "774792325",
            "country_code": "US",
            "telephone_number": "832-939-9999",
            "fax_number": "832-939-9997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4840 Sweetwater Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Sugar Land",
            "state": "TX",
            "postal_code": "774793403",
            "country_code": "US",
            "telephone_number": "832-939-9999",
            "fax_number": "832-939-9997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATYTSIN",
        "first_name": "VLADA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30466",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3403552-05",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3403552-04",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3403552-06",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02608157",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jon A Mathy, M.D.
• Matrix Rehabilitation-Texas, Inc.
• Sara Nicole Matschek, PT
• Eddie Tatsuo Matsu, MD
• Marian Anita Matsu, RN/LSA
• Mauricio a Reinoso
• Mauricio a Reinoso MD PA
• Timothy Mark Mavergeorge, MA, LPC, LMFT, LCDC
• Sarah Mawa, LCSW
• Max DME Supply LLC

• General Practice Dentistry in Sugar Land, TX
• Providers in Sugar Land, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.