Active NPI
Michael Kent Matheson, DDS
- Dentist
- Salt Lake City, UT
National Provider Identifier
1104039809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 362747-9922
- Practice address
- 3939 Wasatch Blvd
Suite 4
Salt Lake City, UT 84124-2216 - Phone
- (801) 424-0027
- Fax
- (801) 424-0029
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 362747-9922 | UT | Primary |
Addresses
Primary practice location
3939 Wasatch Blvd
Suite 4
Salt Lake City, UT 84124-2216
Mailing address
3939 Wasatch Blvd
Suite 4
Salt Lake City, UT 84124-2216
Phone (801) 424-0027
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mmatheson637139@direct.med.utah.edu | Direct | University of Utah |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160114000664 | UT | Order and Referring Only - Dentist | 3577866169 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- UT PPO D-SNP
Interoperability endpoints
- mmatheson637139@direct.med.utah.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1104039809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3939 WASATCH BLVD",
"address_2": "SUITE 4",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841242216",
"telephone_number": "801-424-0027",
"fax_number": "801-424-0029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3939 WASATCH BLVD",
"address_2": "SUITE 4",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841242216",
"telephone_number": "801-424-0027",
"fax_number": "801-424-0029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHESON",
"first_name": "MICHAEL",
"middle_name": "KENT",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "362747-9922",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mmatheson637139@direct.med.utah.edu",
"affiliation": "Y",
"affiliationName": "University of Utah",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/CCD/TXT",
"address_1": "50 N Medical Dr",
"city": "Salt Lake City",
"state": "UT",
"country_code": "US",
"postal_code": "841320001",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.