Jeremy Isak Matis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011813A Issued in IN

Practice address

92D Medical Group
701 Hospital Loop, Suite 350
Fairchild Afb, WA 99011

Phone

(095) 247-4770

NPI assigned

Mar 7, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1053685008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92D MEDICAL GROUP",
            "address_2": "701 HOSPITAL LOOP, SUITE 350",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "99011",
            "telephone_number": "509-247-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92D MEDICAL GROUP",
            "address_2": "701 HOSPITAL LOOP, SUITE 350",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "99011",
            "telephone_number": "095-247-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATIS",
        "first_name": "JEREMY",
        "middle_name": "ISAK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-07",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011813A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Joseph Marcheschi, DO
• P Laurine Marcinkowski, PHD
• Kelly Massey, LSWAIC
• Emily Rose Masters
• Leslie Mathis, PT, DPT
• Collin Douglas Mayer
• Scott Andrew Mazanec, DDS
• Joseph Migliuri, MD
• Megan Milburn
• Paul M Montgomery, IDMT

• General Practice Dentistry in Fairchild Afb, WA
• Providers in Fairchild Afb, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.