Richard Mathias, DMD
Individual provider Active NPI Dentist · Hatch, NM
NPI 1124305875 · NPPES record last updated Nov 9, 2011
Key facts
- NPI
- 1124305875
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DD3617 (NM)
- Practice address
- 255 Highway 187
Hatch, NM 87937-0370 - Phone
- (575) 267-3088
- Fax
- (575) 267-4565
- NPI assigned
- Nov 9, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150529000553 | NM | Order and Referring Only - Dentist |
5890015044 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD3617 | NM | Yes |
Addresses
Primary practice location
255 Highway 187
Hatch, NM 87937-0370
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280
Other providers in Hatch, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2011. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.