Matthew John Nielsen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN-10503 Issued in CO

Practice address

224 W D.L. Ingram
BLD. 1408
Cannon Afb, NM 88103

Phone

(575) 784-4041

NPI assigned

Sep 2, 2011

Sex

Male

Sole proprietor

No

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

Enrolled in AK

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1356622401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "907-580-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 W D.L. INGRAM",
            "address_2": "BLD. 1408",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88103",
            "telephone_number": "575-784-4041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 W Ent Ave",
            "address_2": "Attn: 21 DS/SGDD-Dental Clinic",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809141595",
            "country_code": "US",
            "telephone_number": "719-556-1333",
            "fax_number": "719-556-1331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-02",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN-10503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Joseph Milazzo, M.S.W.
• Lacye Jean Mills, BSN, RN
• Joshua Morales
• Sang Ngo
• Thien H Nguyen, PHARM.D.
• Jason P Nolz, O.D.
• Andrew M Null
• Viviana Nunez, LPN
• Tyler Kinson Palbicke, MD
• Randi Parker, LCSW

• General Practice Dentistry in Cannon Afb, NM
• Providers in Cannon Afb, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; 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.