Ahmed Mataria, D.D.S. PC

Primary specialty

DentistTaxonomy code 122300000X

License

019027955 Issued in IL

Practice address

4934 W 95TH St
Oak Lawn, IL 60453-2504

Phone

(773) 429-1400

Fax

(773) 429-1410

NPI assigned

Jun 2, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, CA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1255567483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4934 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532504",
            "telephone_number": "773-429-1400",
            "fax_number": "773-429-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4934 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532504",
            "telephone_number": "773-429-1400",
            "fax_number": "773-429-1410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3610 Lomita Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905053919",
            "country_code": "US",
            "telephone_number": "323-704-7836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATARIA",
        "first_name": "AHMED",
        "credential": "D.D.S.  PC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS100937",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandyn William Mason, D.O.
• Charles A. Mason, M.D.
• Inonge L. Mason
• Sondos Masoud, PA-C
• Alexandra Michele Masterson, LCSW
• Jalal Mataria, RPH
• Don Mathew
• Travis Jordan Matics, D.O.
• Brandee Leigh Mattera
• Michelle Denise Matthews

• Dentist in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.