Mattson Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MATTSON DENTAL, PLLC

Practice address

1151 E Paris Ave SE Ste 100
Grand Rapids, MI 49546-8369

Phone

(616) 949-5980

NPI assigned

Feb 2, 2021

Organization subpart

No

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

Authorized official

Name

Carmen Bollinger

Title

Practice Manager

Phone

(616) 706-7637

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bander Dental Group Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel Thomas Bander, DDS

  • Dentist
  • Grand Rapids, MI
  • NPI 1336272749
  NPD
• Travis Christian Mattson, D.D.S.

  • Dentist
  • Traverse City, MI
  • NPI 1710240007
  NPD

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1437740313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 E PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468369",
            "telephone_number": "616-949-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 E PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468369",
            "telephone_number": "616-949-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTSON DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "BOLLINGER",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "616-706-7637"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710240007",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@banderdentalgroup.com",
            "affiliation": "Y",
            "affiliationName": "Samuel T. Bander, DDS, PLC",
            "address_1": "1151 E Paris Ave SE Ste 100",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495468369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bander Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bander Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tristan Matthews
• Connie Ruth Mattice, RN
• Mattie Deboe Counseling LLC
• Katie Ann Mattila, NP
• Ashlynn Mattingly, LMSW
• Laura Marie Mattson, D.O.
• Nancy Mattson, RN
• Natalie Mattson, FNP
• Olivia Rene Matvichuk
• Brian Edward Matz, MSPT

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.