Matt Demerle

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901600835 Issued in MI

Practice address

29425 Ryan Rd
Warren, MI 48092-2203

Phone

(586) 755-9340

NPI assigned

Feb 9, 2017

Last updated

Aug 22, 2023By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mdemerle1124945@direct.hfhs.org

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

• Summit Oral & Maxillofacial Surgery PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Warren, MI
  • NPI 1811066129
  NPD (past)

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1285172213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29425 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29425 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922203",
            "telephone_number": "586-755-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMERLE",
        "first_name": "MATT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-09",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901600835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dedicated Physicians Group of Michigan PLLC (Dedicated Senior Medical Center Warren)
• Jami L Dekker, PA
• Delta Primary & Urgent Care PLLC
• Deluxe Dental Associates 9-Warren PLLC (Deluxe Dental)
• Jill F. Dely, PA-C
• Nicholas Demers, MOTRL
• Nicole Lynne Demeter, CNM
• Haley Deming
• Margaret Jacqueline Dengal, DO, MPH
• Dental Design Group PLLC (Dental Design Group)

• Oral and Maxillofacial Surgery (Dentist) in Warren, MI
• Providers in Warren, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.