Active NPI
Robert N Matiasevich Sr., DDS
- Dentist
- Santa Cruz, CA
National Provider Identifier
1417160904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 21480
- Practice address
- 1775 Dominican Way
Santa Cruz, CA 95065 - Phone
- (831) 476-7272
- Fax
- (831) 476-1446
- NPI assigned
- May 8, 2007
- 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 | 21480 | CA | Primary |
Addresses
Primary practice location
1775 Dominican Way
Santa Cruz, CA 95065
Mailing address
1775 Dominican Way
Santa Cruz, CA 95065
Phone (831) 476-7272
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 |
|---|---|---|---|
| 21480 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robert Matiasevich Jr DDS Inc | Dentist | Past | 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.
-
- Dentist
- Santa Cruz, CA
- NPI 1235278441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417160904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1775 DOMINICAN WAY",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "95065",
"telephone_number": "831-476-7272",
"fax_number": "831-476-1446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 DOMINICAN WAY",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "95065",
"telephone_number": "831-476-7272",
"fax_number": "831-476-1446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATIASEVICH",
"first_name": "ROBERT",
"middle_name": "N",
"name_suffix": "Sr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "21480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.