Kortni Lynn Matteson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901021039 Issued in MI

Practice address

820 84TH Street SW
Byron Center, MI 49315

Phone

(616) 455-7310

Fax

(616) 455-0332

NPI assigned

Jun 24, 2013

Sex

Female

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

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Matthew R Vanderlaan DDS PLLC

  • Dentist
  • Byron Center, MI
  • NPI 1083129910
  NPD (past)

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513728000000",
    "number": "1154760015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 84TH STREET SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "49315",
            "telephone_number": "616-455-7310",
            "fax_number": "616-455-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 84TH STREET SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "49315",
            "telephone_number": "616-455-7310",
            "fax_number": "616-455-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTESON",
        "first_name": "KORTNI",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-24",
        "last_updated": "2017-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah L Malins, M.S.
• Mary Manilla
• Mallory Quinn Marlowe, PA
• Elaine Kae Martin
• Ann E Mathias, D.O.
• Matthew R Vanderlaan DDS PLLC
• Angela Maynard, LLPC
• Nicholas Thomas McBride, DPT
• Whitney Diane McKinney, LMSW
• Taylor Nicole McMillen, PSYD

• Dentist in Byron Center, MI
• Providers in Byron Center, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; 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.

Verify at the official NPI Registry.