Edmond Shaun Mayatte, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3156-00 Issued in MS

Practice address

22 Eastgate Dr
Brandon, MS 39042-2318

Phone

(601) 825-1105

Fax

(601) 825-1984

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Mayatte Family Dentistry, LLC

  • General Practice Dentistry
  • Brandon, MS
  • NPI 1316154776
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063505840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 EASTGATE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422318",
            "telephone_number": "601-825-1105",
            "fax_number": "601-825-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 EASTGATE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422318",
            "telephone_number": "601-825-1105",
            "fax_number": "601-825-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYATTE",
        "first_name": "EDMOND",
        "middle_name": "SHAUN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3156-00",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abbigail Jones Mathieu, FNP-C
• Brandon Matthews, MA, PCMHT
• Joanna Kathleen Maxie
• Hannah May, CRNA
• Mayatte Family Dentistry, LLC
• Melissa Claire Mayatte, D.M.D.
• Cora Shannon Maymon, MA, MSM, CCP, PCMHT
• Peighton Mays
• Hazel McCaughan, DMD
• Monica McClellan, MSW

• General Practice Dentistry in Brandon, MS
• Providers in Brandon, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.