Brenton Joseph Matulka, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7575 Issued in NE

Practice address

575 Fallbrook Blvd Ste 107
Lincoln, NE 68521-9040

Phone

(402) 467-0007

Fax

(402) 476-7873

NPI assigned

Jul 10, 2019

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

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.

• Fallbrook Family Dentistry

  • Dentist
  • Lincoln, NE
  • NPI 1750734190
  NPD (past)
• Summit Dental Health - Towne LLC

  dba Summit Dental Health - Fallbrook

  • General Practice Dentistry
  • Lincoln, NE
  • NPI 1831078310
  NPD (past)

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

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562716800000",
    "number": "1619529617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 FALLBROOK BLVD STE 107",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685219040",
            "telephone_number": "402-467-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 FALLBROOK BLVD STE 107",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685219040",
            "telephone_number": "402-467-0007",
            "fax_number": "402-476-7873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATULKA",
        "first_name": "BRENTON",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-10",
        "last_updated": "2019-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "7575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Mattox
• Erin Michelle Mattson
• Patricia M Mattson, RN
• Roger Mattson
• Emily Matuella
• Laura Matulka
• Hanna Matzke
• Michael G. Mauch, D.C.
• Kristen R Maude, CRNA
• Linda S Mauk

• General Practice Dentistry in Lincoln, NE
• Providers in Lincoln, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; 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.