Active NPI
Matthew Louis Bobbera, D.D.S
- Prosthodontics
- Knoxville, TN
National Provider Identifier
1447552047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 9890
- Practice address
- 306 Prosperity Rd
Suite 201
Knoxville, TN 37923-4700 - Phone
- (865) 769-0886
- NPI assigned
- Dec 2, 2010
- Last updated
- Jul 10, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3923 | WV | |
| Prosthodontics | 1223P0700X | 9890 | TN | Primary |
Addresses
Primary practice location
306 Prosperity Rd
Suite 201
Knoxville, TN 37923-4700
Mailing address
306 Prosperity Rd
Suite 201
Knoxville, TN 37923-4700
Phone (304) 692-1822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3923 | WV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1447552047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 PROSPERITY RD",
"address_2": "SUITE 201",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379234700",
"telephone_number": "304-692-1822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 PROSPERITY RD",
"address_2": "SUITE 201",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379234700",
"telephone_number": "865-769-0886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOBBERA",
"first_name": "MATTHEW",
"middle_name": "LOUIS",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-02",
"last_updated": "2014-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "3923",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TN",
"license": "9890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.