Michaela Rose Matos, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

13698 Issued in CT

Practice address

65 Locust Ave Ste 10
New Canaan, CT 06840-4753

Phone

(203) 594-9500

NPI assigned

Apr 5, 2022

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722729600000",
    "number": "1043951809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 STONEFENCE RD",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067701552",
            "telephone_number": "203-690-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 LOCUST AVE STE 10",
            "city": "NEW CANAAN",
            "state": "CT",
            "postal_code": "068404753",
            "telephone_number": "203-594-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATOS",
        "first_name": "MICHAELA",
        "middle_name": "ROSE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2024-08-04",
        "certification_date": "2024-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "13698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "980657435",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hilary Manges
• Susan Mao, PHD
• George Jeffrey Marchese, LPC
• Daniel Evan Mason, MD
• Alicia Masucci, MD
• Matrix Personalized Medicine LLC
• Ann Bonner McCarthy, MS CCC-SLP
• Kristin D Mehta, AGPCNP
• Holly Dale Mensching
• Alexandra Minicucci, LCSW

• Pediatric Dentistry in New Canaan, CT
• Providers in New Canaan, CT by specialty
• Pediatric Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2024; 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.