Individual provider Active NPI

Elizabeth Landry Mathews, DDS

  • General Practice Dentistry
  • Bossier City, LA
National Provider Identifier
1184725822
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4976 Issued in LA
Practice address
4438 Viking Dr Ste 100
Bossier City, LA 71111-7510
Phone
(318) 747-2666
Fax
(318) 747-6610
NPI assigned
Sep 26, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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 4976 LA Primary

Addresses

Primary practice location

4438 Viking Dr Ste 100
Bossier City, LA 71111-7510

Mailing address

4438 Viking Dr Ste 100
Bossier City, LA 71111-7510
Phone (318) 747-2666

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

LicenseStateTypeSpecialty
4976LAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Lagniappe Dental North LLC General Practice CurrentSince Aug 13, 2023 Accepting new patients

Locations

4438 Viking Dr
Ste 100
Bossier City, LA 71111
Phone (318) 747-2666

Organizations & group practices 1

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1184725822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4438 VIKING DR STE 100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117510",
            "telephone_number": "318-747-2666",
            "fax_number": "318-747-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4438 VIKING DR STE 100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117510",
            "telephone_number": "318-747-2666",
            "fax_number": "318-747-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "ELIZABETH",
        "middle_name": "LANDRY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.