Gary Lee Mattson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9083 Issued in MN

Practice address

113 Litchfield Ave SE
Willmar, MN 56201-3628

Phone

(320) 235-9551

Fax

(320) 235-6786

NPI assigned

Feb 26, 2007

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245366186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LITCHFIELD AVE SE",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013628",
            "telephone_number": "320-235-9551",
            "fax_number": "320-235-6786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LITCHFIELD AVE SE",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013628",
            "telephone_number": "320-235-9551",
            "fax_number": "320-235-6786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTSON",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Jay Marcus, D.D.S.
• Jessica Marie Martens, LPCC
• Jessica Jo Martinez, FNP
• Scott Adam Martinka, D.D.S.
• Steven Charles Martinka, D.D.S.
• Kristin Maxson
• Michael Anthony May, M.D.
• Mohamed Maygag
• Njeru Muraguri Mbirianjau
• Nelva Trudy McAdams, RNFNPC

• General Practice Dentistry in Willmar, MN
• Providers in Willmar, MN by specialty
• General Practice Dentistry in Minnesota

• 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.

Verify at the official NPI Registry.