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DR. MATTHEW E TICICH DMD NPI 1407297484


NPI Information

NPI: 1407297484
Provider Name: DR. MATTHEW E TICICH, DMD
Classification: Dentist - 1223E0200X
Entity Type: Individual

Specialization: Endodontics

PECOS Registration: Yes

Address:
6145 DESERT STORM AVE
FORT CAMPBELL, KY
ZIP 42223
Phone: (951) 529-2070
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DR. Matthew E Ticich, DMD is an endodontics dentist in Fort Campbell, KY. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. DR. Matthew E Ticich, DMD NPI is 1407297484. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6145 DESERT STORM AVE
FORT CAMPBELL, KY
ZIP 42223-558
Phone: (951) 529-2070

The NPI 1407297484 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 7/8/2013 and was last updated on 3/24/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentistDEN.00203425COLORADONo
21223G0001XDentistGeneral Practice31790TEXASNo
31223G0001XDentistGeneral Practice62475CALIFORNIANo
41223E0200XDentistEndodontics11869TENNESSEEYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.