Active NPI
Thomas Michael Mattern, D.D.S.
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1295732337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D3892
- Practice address
- 4609 E Chandler Blvd
Phoenix, AZ 85048-0424 - Phone
- (480) 706-4600
- NPI assigned
- Jul 5, 2005
- Last updated
- May 21, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D3892 | AZ | Primary |
Addresses
Primary practice location
4609 E Chandler Blvd
Phoenix, AZ 85048-0424
Mailing address
4609 E Chandler Blvd
Phoenix, AZ 85048-0424
Phone (480) 706-4600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3892 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Desert Dentistry, PLLC | General Practice | Past | Accepting new patients |
| Desert Dentistry, PLLC | Past | Accepting new patients | |
| Kristen M Mayorga PLLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1295732337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4609 E CHANDLER BLVD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850480424",
"telephone_number": "480-706-4600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4609 E CHANDLER BLVD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850480424",
"telephone_number": "480-706-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTERN",
"first_name": "THOMAS",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-05",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D3892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
- Mattalino Orthopaedic Sports Surgical Specialists, LLC
- Shadi Daniel Mattar, DPM
- Kelsey Mattas, DACHM, LAC
- Terrence M Matteo, PH.D.
- Cameron Michele Mattern
- Kaiya Matteson
- Danielle Rodgers Matteucci, LCSW
- Matthew Dorchester, DC, CCSP, LLC
- Matthew J Cavendish, DDS, PLLC
- Matthew Lonier DDS, PLLC (North Central Family Dentistry)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; 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.