Matthew Charles Mandeville, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901015862 Issued in MI

Practice address

4944 Skyview CT
Traverse City, MI 49684-7173

Phone

(231) 947-4566

NPI assigned

Jan 4, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Northern Michigan Pediatric Dentistry

  • Dental Clinic/Center
  • Traverse City, MI
  • NPI 1275685265
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598812422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 SKYVIEW CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847173",
            "telephone_number": "231-947-4566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4944 SKYVIEW CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847173",
            "telephone_number": "231-947-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDEVILLE",
        "first_name": "MATTHEW",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901015862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2974192",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "D158620",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abdul M Malik, M.D.
• Elaine Joy-Peterson Maloney, NP
• Patrick Maloney, PHARMD
• Management & Behavior Consultants, P. C.
• Debra A Mandenberg
• Charity Manke, MA, LLP
• Michelle Manley, DO
• Jan Alexandria Manning, DDS
• Lovell Tracy Manning
• Kimberly Manrique, M.S, L.P.C., A.T.R

• Pediatric Dentistry in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Pediatric Dentistry in Michigan

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.