Artem Matatov

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN26396 Issued in FL

Practice address

711 Boston Post Rd
Old Saybrook, CT 06475-2125

Phone

(860) 388-0242

NPI assigned

Aug 30, 2021

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

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Professional Dental Alliance of Old Saybrook, PLLC

  • General Practice Dentistry
  • Old Saybrook, CT
  • NPI 1235620774
  NPD (past)

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1477220184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 65TH RD APT 4A",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743510",
            "telephone_number": "929-370-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 BOSTON POST RD",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064752125",
            "telephone_number": "860-388-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATATOV",
        "first_name": "ARTEM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN26396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marguerite Ruppenicker LLC
• Courtney Mariita, LCSW
• Jillian Marmaras, MS ED, BCBA
• Debra Ellen Mashberg, PH.D.
• Maria Masotta, PSY.D.
• Matthew J. Hoffman, LMFT, LLC
• Cynthia T. Matthew, PH.D.
• MC Diagnostic of Connecticut, P.C.
• James R McAraw, D.M.D.
• Amanda Rau McKenna

• General Practice Dentistry in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.

Verify at the official NPI Registry.