Dale Robert Mathis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4879 Issued in OK

Practice address

5404 S Memorial Dr
Suite a
Tulsa, OK 74145-9042

Phone

(918) 663-5215

Fax

(918) 663-7030

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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 OK

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McCammon Dental PLLC

  • Dental Clinic/Center
  • Tulsa, OK
  • NPI 1164349916
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548287154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 SOUTH MEMORIAL DRIVE",
            "address_2": "SUITE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74145",
            "telephone_number": "918-663-5215",
            "fax_number": "918-663-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5404 S MEMORIAL DR",
            "address_2": "SUITE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741459042",
            "telephone_number": "918-663-5215",
            "fax_number": "918-663-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "DALE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Mathias III, D.O.
• Ashley Nichole Mathis Cooper, APRN
• Jennifer Lynne Mathis-Colley, L.P.C.
• Andrew Scott Mathis
• Conner Jacob Mathis, BS
• Danielle Mathis
• Mary Anne Mathis
• Tracie Kennon Mathis, RD/LD IBCLC
• Gina Matlock, APRN
• Hagan Patrick Matlock, MD

• General Practice Dentistry in Tulsa, OK
• Providers in Tulsa, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.