Matthew Eric Robertson, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

60512 Issued in KS

Practice address

12611 E 21St St N
Wichita, KS 67206-3594

Phone

(316) 742-1506

NPI assigned

Apr 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 19, 2018 through Dec 19, 2026

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.

• Wichita Oral Surgery LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Wichita, KS
  • NPI 1164914982
  NPD (past)

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1750343802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12611 E 21ST ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063594",
            "telephone_number": "316-742-1506",
            "fax_number": "316-742-1507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12611 E 21ST ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063594",
            "telephone_number": "316-742-1506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 N Georgie Ave",
            "address_purpose": "LOCATION",
            "city": "Derby",
            "state": "KS",
            "postal_code": "670371701",
            "country_code": "US",
            "telephone_number": "316-746-0015",
            "fax_number": "316-746-0078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MATTHEW",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "21514",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KS",
            "license": "60512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "12345",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teffany Roberts
• Stephanie Anne Robertson-Cameron, DDS
• Amy Deanne Robertson, PHARMD
• Jeanette Michelle Robertson, PH.D., LCMFT
• Kendall Robertson
• Megan Rene Robertson, CRNA
• Monica L Robertson, OTR
• Robertsville Dialysis LLC (Air Capital Dialysis)
• Terry Lee Robey, LCMFT, LCAC
• John C Robichaux, MD

• Oral and Maxillofacial Surgery (Dentist) in Wichita, KS
• Providers in Wichita, KS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.