Matthew Ticich, DMD
Matthew Ticich, DMD is a provider specialising in Endodontics in Fort Campbell, KY, registered under NPI 1407297484. This provider registers 3 separate taxonomy codes, which usually means they practise across more than one recognised specialty. NPPES records them as a sole proprietor, meaning the practice is not incorporated as a separate legal entity.
Getting there
The practice address on file is 6145 DESERT STORM AVE, Fort Campbell, KY 42223. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| 11869 | TN | Endodontics |
| DEN.00203425 | CO | Dentist |
| 62475 | CA | Endodontics primary |
| 31790 | TX | General Practice Dentistry |
Licences are recorded in 4 states: TN, CO, CA, TX. Providers licensed in several states often practise near a state border or deliver telehealth across state lines.
- Status
- Approved
- Provider type
- Order And Referring Only - Dentist
- PAC ID
- 4284080441
- Enrollment ID
- I20231024001902
Medicare enrolment is recorded as approved under the provider type Order And Referring Only - Dentist. Being enrolled means the provider can bill Medicare; it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
Licensed in 4 states
This provider holds licences in 4 states: California, Colorado, Tennessee and Texas. Multi-state licensure often means the provider works near a state border, covers more than one office, or delivers care by telehealth. If the address above is far from you, it is worth calling to ask whether they practise closer to where you live.
Licence numbers are self-reported to NPPES at registration. They do not confirm a licence is currently active, in good standing, or valid for the specialty shown — only the state board can tell you that, which is why we link to each one.
What Endodontics covers
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. NUCC Health Care Provider Taxonomy, code 1223E0200X
All registered taxonomy codes
This provider registers 4 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 1223E0200X | Endodontics Endodontics | 11869 | TN | |
| 122300000X | Dentist | DEN.00203425 | CO | |
| 1223E0200X | Endodontics Endodontics | 62475 | CA | primary |
| 1223G0001X | General Practice Dentistry General Practice | 31790 | TX |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-1 identifies a single person. It stays with the clinician for life, even if they move practice or change state, which is why the address on file can lag behind where they actually work today.
| NPI | 1407297484 valid check digit |
|---|---|
| Entity type | Individual (NPI-1) |
| Enumeration date | Jul 8, 2013 |
| Last updated | Jul 8, 2026 |
| Status | Active |
| Sole proprietor | Yes |
| Gender | Male |
| Credential | DMD |
| Practice address |
6145 DESERT STORM AVE Fort Campbell, KY 42223 (951) 529-2070 |
| Mailing address |
40203 ODESSA DR Temecula, CA 92591 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 4 | 0 | 7 | 2 | 9 | 7 | 4 | 8 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 4 | 0 | 7 | 4 | 9 | 5 | 4 | 7 |
Sum = 66 · next multiple of 10 = 70 · check digit = 4 · actual last digit = 4
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.