Kent M Mattison, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN008284 Issued in GA

Practice address

2381 Main St E Ste B
Snellville, GA 30078-3358

Phone

(770) 972-4666

NPI assigned

Jul 15, 2006

Sex

Male

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kent M. Mattison, D.M.D., P.C.

  • General Practice Dentistry
  • Snellville, GA
  • NPI 1114059706
  NPD (past) Authorized official

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922024454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2381 MAIN ST E STE B",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783358",
            "telephone_number": "770-972-4666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2381 MAIN ST E STE B",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783358",
            "telephone_number": "770-972-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTISON",
        "first_name": "KENT",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN008284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Celine Mathew, D.O.
• Geo Mary Mathew
• Justin Thomas Mathew, PT, DPT
• Roy Mathew
• Lynette Mathis
• Mattlet Health
• Gregory Loy Mauldin, MD
• John E Maxa, M.D.
• Daniel William Maxwell, DO
• Raoul Mayer, M.D.

• Dentist in Snellville, GA
• Providers in Snellville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.