Active NPI
Brian Cole Mathison, DDS
- Dentist
- Fargo, ND
National Provider Identifier
1063424232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1887
- Practice address
- 4742 Amber Valley Pkwy S
Fargo, ND 58104-8614 - Phone
- (701) 356-3999
- Fax
- (701) 356-4088
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1887 | ND | Primary |
Addresses
Primary practice location
4742 Amber Valley Pkwy S
Fargo, ND 58104-8614
Mailing address
4742 Amber Valley Pkwy S
Fargo, ND 58104-8614
Phone (701) 356-3999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 971887 | Other | ND | DENTAL SERVIC CORP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355875200000",
"number": "1063424232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4742 AMBER VALLEY PKWY S",
"city": "FARGO",
"state": "ND",
"postal_code": "581048614",
"telephone_number": "701-356-3999",
"fax_number": "701-356-4088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4742 AMBER VALLEY PKWY S",
"city": "FARGO",
"state": "ND",
"postal_code": "581048614",
"telephone_number": "701-356-3999",
"fax_number": "701-356-4088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHISON",
"first_name": "BRIAN",
"middle_name": "COLE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2012-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ND",
"license": "1887",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL SERVIC CORP",
"identifier": "971887",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.