Active NPI
Prisco Halili Matro, DENTAL HYGIENIST
- Dental Hygienist
- Oak Harbor, WA
National Provider Identifier
1205416625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- Practice address
- 1339 NE Big Berry Loop
Oak Harbor, WA 98277-3510 - Phone
- (360) 969-6637
- NPI assigned
- Apr 9, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH28287 | FL | |
| Dental Hygienist | 124Q00000X | Primary |
Addresses
Primary practice location
1339 NE Big Berry Loop
Oak Harbor, WA 98277-3510
Mailing address
1339 NE Big Berry Loop
Oak Harbor, WA 98277-3510
Phone (360) 969-6636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH28287 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617926400000",
"number": "1205416625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1339 NE BIG BERRY LOOP",
"city": "OAK HARBOR",
"state": "WA",
"postal_code": "982773510",
"telephone_number": "360-969-6636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1339 NE BIG BERRY LOOP",
"city": "OAK HARBOR",
"state": "WA",
"postal_code": "982773510",
"telephone_number": "360-969-6637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATRO",
"first_name": "PRISCO",
"middle_name": "HALILI",
"credential": "DENTAL HYGIENIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-09",
"last_updated": "2021-04-09",
"certification_date": "2021-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "DH28287",
"primary": false
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.