Christian Mattingly

Primary specialty

DentistTaxonomy code 122300000X

License

600184415 Issued in WI

Practice address

115 5TH Ave N
Hurley, WI 54534-1208

Phone

(715) 329-1288

NPI assigned

Jun 9, 2025

Sex

Female

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

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.

• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hurley, WI
  • NPI 1437719267
  NPD
• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
  • NPI 1679983423
  NPD (past)

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1962397224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 5TH AVE N",
            "city": "HURLEY",
            "state": "WI",
            "postal_code": "545341208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 5TH AVE N",
            "city": "HURLEY",
            "state": "WI",
            "postal_code": "545341208",
            "telephone_number": "715-329-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "CHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "600184415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hurley School District
• Alyssa Nichole Kitzman I, L.P.N.
• Jessica Marie Leinon-Novascone, LMSW
• Margaret Livingston, REGISTERED NURSE
• Shannon Rae Lutz, LCSW
• Christina Musch, PTA
• Northwoods Family Orthopaedics S.C.
• Northwoods Family Orthopaedics, S.C.
• Ifeoma F Nwoye, MD
• Grady O'Neill, MA

• All providers in Hurley, WI
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.