Jacquelyn P Mathews, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6966-15 Issued in WI

Practice address

28451 N Vistancia Blvd
Suite 101
Peoria, AZ 85383-2090

Phone

(623) 218-6638

NPI assigned

Aug 8, 2012

Sex

Female

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 24, 2017 through Apr 24, 2027

Medicare enrollment (NPD)

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.

• Legacy Smiles, LLP

  • General Practice Dentistry
  • Peoria, AZ
  • NPI 1609052042
  NPD (past)
• Vistancia Dental Group, Professional Corporation

  • General Practice Dentistry
  • Peoria, AZ
  • NPI 1093989329
  NPD (past)

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424304000000",
    "number": "1649527730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 E BRENTRUP DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852834782",
            "telephone_number": "480-861-5338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28451 N VISTANCIA BLVD",
            "address_2": "SUITE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853832090",
            "telephone_number": "623-218-6638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "JACQUELYN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2015-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6966-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Ann Mason, PH.D
• Kalah Masterson, LMSW
• Robert Mastikian, PSY.D.
• Shayna Elizabeth Matelis, RN
• Anupama K Mathew, M.D.
• Andrea W Mathiason, FNP-C
• Annamaria Matic
• Bradley Green Matson, DC
• Donovan Mattfeldt
• Matthew G. Noll DDS PLLC

• General Practice Dentistry in Peoria, AZ
• Providers in Peoria, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.