Active NPI
Matthew William Harris, DMD
- Dentist
- Granite Bay, CA
National Provider Identifier
1285989996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61530
- Practice address
- 6965 Douglas Blvd
Granite Bay, CA 95746-6256 - Phone
- (916) 778-4100
- Fax
- (916) 778-4101
- NPI assigned
- Jul 18, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61530 | CA | Primary |
Addresses
Primary practice location
6965 Douglas Blvd
Granite Bay, CA 95746-6256
Mailing address
6965 Douglas Blvd
Granite Bay, CA 95746-6256
Phone (916) 778-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181120001179 | CA | Order and Referring Only - Dentist | 0143574632 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61530 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matthew Harris DMD Professional Corporation | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Auburn, CA
- NPI 1053934273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342569600000",
"number": "1285989996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6965 DOUGLAS BLVD",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466256",
"telephone_number": "916-778-4100",
"fax_number": "916-778-4101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6965 DOUGLAS BLVD",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466256",
"telephone_number": "916-778-4100",
"fax_number": "916-778-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "MATTHEW",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-18",
"last_updated": "2012-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "61530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite Bay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; 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.