Mattison Donaldson, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

105501 Issued in CA

Practice address

362 E Vanderbilt Way
San Bernardino, CA 92408-3593

Phone

(909) 384-1111

NPI assigned

Sep 16, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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.

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1962018945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44100 JEFFERSON ST STE 404",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922019014",
            "telephone_number": "760-772-0214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 E VANDERBILT WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083593",
            "telephone_number": "909-384-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "770 Magnolia Ave # J",
            "address_purpose": "LOCATION",
            "city": "Corona",
            "state": "CA",
            "postal_code": "928793120",
            "country_code": "US",
            "telephone_number": "951-736-0603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONALDSON",
        "first_name": "MATTISON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-16",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "105501",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "105501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noel Dominguez
• Stephanie Dominguez
• Sylivia A Dominguez
• Donald R Jary PHD & Associates Apc
• Marquez Donaldson
• Azucena Donan
• Aimee Lou Donato, PSY.D.
• Steve Dong, M.D.
• Kate Donkor, F.N.P.
• Irene Donley Kimble, MD

• Endodontics in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.