NPIMap

Organization Active NPI

Matthew a. Bagnulo, DDS, PS

  • General Practice Dentistry
  • Kirkland, WA
National Provider Identifier
1053978064
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MATTHEW A. BAGNULO, DDS, PS
Practice address
11830 NE 128TH St., #202
Kirkland, WA 98034
Phone
(425) 821-9000
Fax
(425) 814-2908
NPI assigned
May 24, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matthew Adam Bagnulo, DDSNPI 1982799987
Title
Owner
Phone
(425) 821-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

11830 NE 128TH St., #202
Kirkland, WA 98034

Mailing address

11830 NE 128TH St., #202
Kirkland, WA 98034
Phone (425) 821-9000

National Provider Directory

National Provider Directory

Locations

11830 NE 128th St
Ste 202
Kirkland, WA 98034
Phone (425) 821-9000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1558656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558656000000",
    "number": "1053978064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11830 NE 128TH ST., #202",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034",
            "telephone_number": "425-821-9000",
            "fax_number": "425-814-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11830 NE 128TH ST., #202",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034",
            "telephone_number": "425-821-9000",
            "fax_number": "425-814-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW A. BAGNULO, DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-24",
        "last_updated": "2019-05-24",
        "status": "A",
        "authorized_official_last_name": "BAGNULO",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-821-9000",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; 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.