Matthew Scott Detar, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

0401411877 Issued in VA

Practice address

10682 Crestwood Dr Ste C
Manassas, VA 20109-4401

Phone

(703) 368-8120

NPI assigned

May 21, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Loudoun Endodontics, PLLC

  • Endodontics
  • Leesburg, VA
  • NPI 1588303556
  NPD Authorized official
• Reston Endodontics, PLLC

  • Endodontics
  • Reston, VA
  • NPI 1992444970
  NPD Authorized official
• DRS. Dollard, Piccinino & Thorpe, P.C.

  • Endodontics
  • Manassas, VA
  • NPI 1295829257
  NPD (past)
• Reston Dental Group, PC

  • Dental Clinic/Center
  • Reston, VA
  • NPI 1427128669
  NPD (past)

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1073770608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10682 CRESTWOOD DR STE C",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201094401",
            "telephone_number": "703-368-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10682 CRESTWOOD DR STE C",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201094401",
            "telephone_number": "703-368-8120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11503 Sunrise Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201911505",
            "country_code": "US",
            "telephone_number": "703-860-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETAR",
        "first_name": "MATTHEW",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-21",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401411877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Virginia, P.C (Dental Care of Manassas)
• Dentists of Sudley, PC (Dentists of Sudley)
• Melat Dereje
• Parimal C Desai, MD
• Jemima M Desir Telus, FNP
• Genevieve Devera, DDS
• Dezira Dewhurst, B.S., BCABA, LABA
• McKenzie Dewhurst, RBT
• Millicent Deya, RPH
• DG Counseling Company

• Endodontics in Manassas, VA
• Providers in Manassas, VA by specialty
• Endodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.