John Mathis, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

4139-20 Issued in MS

Practice address

1013 W Jackson St
Tupelo, MS 38804-1907

Phone

(662) 823-7900

Fax

(662) 823-7920

NPI assigned

Jul 22, 2020

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Mathis Dental, LLC

  • Dental Clinic/Center
  • Tupelo, MS
  • NPI 1922703644
  NPD Authorized official
• Marquis Dental Center PA

  • Customized Equipment (DME)
  • Tupelo, MS
  • NPI 1508293531
  NPD (past)
• Sharon Elise Young DMD PLLC

  • Dentist
  • Tupelo, MS
  • NPI 1962100610
  NPD (past)
• Young Dentistry

  • Dentist
  • Tupelo, MS
  • NPI 1841618915
  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1669080081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 W JACKSON ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388041907",
            "telephone_number": "662-823-7900",
            "fax_number": "662-823-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 W JACKSON ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388041907",
            "telephone_number": "662-823-7900",
            "fax_number": "662-823-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-22",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "4139-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4139-20",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.mathisdentalms.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1013 W Jackson St",
            "city": "Tupelo",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388041907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• F. Mitchell Massey, M.D.
• Chester Warren Masterson III
• Louis Masur III, PHD
• Dan Robbins Mathews Jr., D.C
• Mathis Dental, LLC
• Taylor Phillips Mathis, MD
• John Mark Matthews, MD
• Kimberly M Matthews
• Rachel Corey Mauldin, NP
• Heather L Mauney, COTA

• Dentist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.