Search › Kentucky › 1223E0200X
Matthew Ticich, DMD
NPI 1407297484 · on the registry since 2013 · sole proprietor
Practice
- Address
- 6145 Desert Storm Ave
Fort Campbell, KY 42223 - Phone
- (951) 529-2070
- Clinicians at this address
- 10
Registry record
- Primary taxonomy
- 1223E0200X
1223E0200X
- Also registered as
- 1223E0200X
122300000X
1223G0001X - Licence states on file
- TN, CA, CO, TX
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2026-09-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Kentucky