Individual provider Active NPI

Janellen G Matyas, DDS

  • General Practice Dentistry
  • New London, CT
National Provider Identifier
1104945708
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6895 Issued in CT
Practice address
4 Shaws CV Ste 202
New London, CT 06320-4956
Phone
(860) 443-4199
Fax
(860) 444-6145
NPI assigned
Mar 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6895 CT Primary

Addresses

Primary practice location

4 Shaws CV Ste 202
New London, CT 06320-4956

Mailing address

4 Shaws CV Ste 202
New London, CT 06320-4956
Phone (860) 443-4199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20150515001327 CT Order and Referring Only - DentistPractitioner - Dentist 8820318710

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6895CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
DRS. Matyas & Matyas General Practice Past Accepting new patients
Matyas Family Dental, PLLC General Practice PastSince Dec 12, 2021 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104945708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SHAWS CV STE 202",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204956",
            "telephone_number": "860-443-4199",
            "fax_number": "860-444-6145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SHAWS CV STE 202",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204956",
            "telephone_number": "860-443-4199",
            "fax_number": "860-444-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATYAS",
        "first_name": "JANELLEN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "6895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.