Mica Mathison, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS0000010581 Issued in TN

Practice address

2946 Winfield Dunn Pkwy
Kodak, TN 37764-4306

Phone

(865) 465-7058

NPI assigned

Feb 11, 2017

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 26, 2020.

{
    "created_epoch": "1486771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1891233722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2946 WINFIELD DUNN PKWY",
            "city": "KODAK",
            "state": "TN",
            "postal_code": "377644306",
            "telephone_number": "865-465-7058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 WINFIELD DUNN PKWY",
            "city": "KODAK",
            "state": "TN",
            "postal_code": "377644306",
            "telephone_number": "865-465-7058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHISON",
        "first_name": "MICA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-11",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015719",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS0000010581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Lynn Lester, FNP-BC
• Lifechangers Outreach
• Ethan Michael Long, DDS
• Ashlyn Jones Loy, PHARMD.
• Kenna Nicole Major, APRN
• Elizabeth Coleen McDonald
• William Mitchell, DPT
• Mountain Medical Services PLLC
• Nationalrx, Inc
• Saman Perera

• All providers in Kodak, TN
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.