Erick Evandro Di Matteo

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

37306 Issued in TX

Practice address

444 Forest SQ Ste a
Longview, TX 75605-4463

Phone

(903) 758-3329

NPI assigned

Mar 20, 2018

Last updated

Aug 15, 2022By 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

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1295239713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 MADISINA DR",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786412639",
            "telephone_number": "407-552-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 FOREST SQ STE A",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756054463",
            "telephone_number": "903-758-3329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1395 Center Dr # D1-D9",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326103006",
            "country_code": "US",
            "telephone_number": "352-273-7846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DI MATTEO",
        "first_name": "ERICK",
        "middle_name": "EVANDRO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-20",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "37306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cleta (Beth) Derkowski, SLP
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• Lori Desadier, APRN, AGPC-NP
• Austin Deschner, M.D.
• Sita Mahalakshmi Devulapalli, M.D.
• Diagnostic Clinic of Longview PA
• Diagnostic Health Solutions, LLC
• Taylor Griffin Dickerson, MD
• Andrew Dickhute
• Lois Ann Dietrich, PT

• Periodontics in Longview, TX
• Providers in Longview, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.