Active NPI
Wayne A Mattern, DDS
- Dentist
- Bismarck, ND
National Provider Identifier
1124183728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- ND1454
- Practice address
- 1714 N 9TH St
Bismarck, ND 58501 - Phone
- (701) 223-1474
- Fax
- (701) 224-0038
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- Sole proprietor
- No
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 | ND1454 | ND | Primary |
Addresses
Primary practice location
1714 N 9TH St
Bismarck, ND 58501
Mailing address
1714 N 9TH St
Bismarck, ND 58501
Phone (701) 223-1474
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40411 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND1454 | ND | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124183728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1714 N 9TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "58501",
"telephone_number": "701-223-1474",
"fax_number": "701-224-0038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1714 N 9TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "58501",
"telephone_number": "701-223-1474",
"fax_number": "701-224-0038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTERN",
"first_name": "WAYNE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ND",
"license": "ND1454",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40411",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.