Duncan Fairley Matheson IV, DDS
Individual provider Active NPI Dentist · Diamondhead, MS
NPI 1073729307 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1073729307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 325803 (MS)
- Practice address
- 5404 Indian Hill Blvd
Diamondhead, MS 39525-3334 - Phone
- (228) 255-2543
- NPI assigned
- May 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 22, 2016 through Feb 22, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 325803 | MS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duncan F Matheson III DDS PA | Current | Accepting new patients |
Locations
5404 Indian Hill Blvd
Diamondhead, MS 39525
Phone (228) 255-2543
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 325803 | MS | Yes |
Addresses
Primary practice location
5404 Indian Hill Blvd
Diamondhead, MS 39525-3334
Mailing address
5404 Indian Hill Blvd
Diamondhead, MS 39525-3334
Other providers in Diamondhead, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.