Dexter Witherington Mattox, DMD, MD
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Brunswick, GA
NPI 1285083527 · NPPES record last updated Jan 29, 2025
Key facts
- NPI
- 1285083527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- DN015216 (GA)
- Practice address
- 149 Scranton Connector
Brunswick, GA 31525-0514 - Phone
- (912) 266-8100
- Fax
- (912) 266-8125
- NPI assigned
- Jun 7, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 9, 2021 through Jul 9, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN015216 | GA | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innova Sleep Institute, LLC | Oral and Maxillofacial Surgery | Current |
Accepting new patients |
| Southeastern Oral and Maxillofacial Surgical Associates P.C. | Oral and Maxillofacial Surgery | Past |
Accepting new patients |
| Georgia Dental Affiliates, LLC | Oral and Maxillofacial Surgery | Past |
Accepting new patients |
| Jackson P. Morgan, III, PC | Oral and Maxillofacial Surgery | Past |
Accepting new patients |
| Georgia Dental Affiliates, LLC | Oral and Maxillofacial Surgery | Past |
Accepting new patients |
| Coastal Oral Surgery Associates | Oral and Maxillofacial Surgery | Past |
Accepting new patients |
Locations
149 Scranton Connector
Brunswick, GA 31525
Phone (912) 266-8100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DN015216 | GA | Yes |
Addresses
Primary practice location
149 Scranton Connector
Brunswick, GA 31525-0514
Mailing address
149 Scranton Connector
Brunswick, GA 31525-0514
Phone (912) 266-8100
Other providers in Brunswick, GA
- Jeon Carter Martinez
- Gilberto J Martorell-Marquez
- Joe C. Massey
- Samantha Marie Massey
- Wendy Mathis
- Huitt Everett Mattox III
- Katherine L Maurath
- Janice H. Maxwell
- Mary Virginia May
- Thomas Geoffrey May
All providers in Brunswick, GA · Oral and Maxillofacial Surgery (Dentist) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2025. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.