Healthcare Provider Details

I. General information

NPI: 1356627756
Provider Name (Legal Business Name): MATTHEW FOGG TINGEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 E LINCOLN LN
GARDNER KS
66030-1594
US

IV. Provider business mailing address

813 E LINCOLN LN
GARDNER KS
66030-1594
US

V. Phone/Fax

Practice location:
  • Phone: 913-938-4058
  • Fax:
Mailing address:
  • Phone: 801-884-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60853
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: