Active NPI
Matthew Carbajal, DDS
- Student in an Organized Health Care Education/Training Program
- Detroit, MI
National Provider Identifier
1275161754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 2951000934
- Practice address
- 2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576 - Phone
- (313) 494-6611
- NPI assigned
- Mar 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D011158 | AZ | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 2951000934 | MI | Primary |
Addresses
Primary practice location
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Mailing address
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
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 |
|---|---|---|---|
| D011158 | AZ | MD | General Practice Dentistry |
| 2951000934 | MI | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687478400000",
"number": "1275161754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARBAJAL",
"first_name": "MATTHEW",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-30",
"last_updated": "2023-06-23",
"certification_date": "2023-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D011158",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "2951000934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.