Nicholas A Massoth, D.M.D.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

D 3848 OS Issued in ID

Practice address

4121 Clock Tower Ave
Caldwell, ID 83607-5006

Phone

(208) 459-7800

Fax

(208) 455-8452

NPI assigned

Jul 4, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 1, 2026 through May 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Canyon County Oral Maxillofacial Surgery, Inc

  dba Canyon County Oral Maxillofacial Surgery

  • Oral and Maxillofacial Pathology Dentistry
  • Caldwell, ID
  • NPI 1710184783
  NPD Authorized official

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1114957917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 CLOCK TOWER AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836075006",
            "telephone_number": "208-459-7800",
            "fax_number": "208-455-8452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 CLOCK TOWER AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836075006",
            "telephone_number": "208-459-7800",
            "fax_number": "208-455-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSOTH",
        "first_name": "NICHOLAS",
        "middle_name": "A",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "ID",
            "license": "D 3848 OS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariana Maritato, M.S. CCC-SLP
• Susan M Martinelli, LCSW
• Jessica Martinez, LMSW
• Joe Martinez
• Monique Massey, NP
• Penny Angel Mata, MEDICAL ASSISTANT
• Charlotte Matos
• John Clark Mayberry, MD
• Sara L McClellin, LCSW
• Paul A McConnel, MD

• Oral and Maxillofacial Pathology Dentistry in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Oral and Maxillofacial Pathology Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.