Drsgm LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

DRSGM LLC

Practice address

10520 S 204TH St Ste C
Gretna, NE 68028-4185

Phone

(402) 403-6007

Fax

(402) 403-1243

NPI assigned

Nov 13, 2023

Organization subpart

No

Name

Dr. Shayna Mattox, DDSNPI 1811334857

Title

Owner

Phone

(402) 319-6688

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shayna L Mattox, DDS

  • Pediatric Dentistry
  • Gretna, NE
  • NPI 1811334857
  NPD Authorized official

Locations

• Treehouse Pediatric Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 13, 2024.

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1053185702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10520 S 204TH ST STE C",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680284185",
            "telephone_number": "402-403-6007",
            "fax_number": "402-403-1243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10520 S 204TH ST STE C",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680284185",
            "telephone_number": "402-403-6007",
            "fax_number": "402-403-1243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRSGM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "MATTOX",
        "authorized_official_first_name": "SHAYNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-319-6688",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10029073600",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Treehouse Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shaylee Dirks, PTA
• Robert Dishong
• Twyla Dishong
• Matthew Barton Donelan, PT
• Maya Douchey, OT
• Katherine Duggins, PHARM.D.
• Dynamic Physical Therapy LLC
• Lori Sue Eccleston
• Philip Andrew Ehly, DDS
• Miranda Erickson

• All providers in Gretna, NE
• Pediatric Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.